Distraction injuries, T7-8 and T11-12 with severe cord injury and ligament disruption
Findings:
Sagittal reconstruction from thoracic and lumbar spine CT demonstrates abnormal widening of the T11-12 and T7-8 disc spaces. Fractures are seen along the inferior endplates in these regions, and multiple spinous process fractures are incompletely demonstrated. The CT demonstrates slight anterior subluxation at T7-8. The MR images demonstrate improved distraction of the thoracic disk space injuries. Multi ligamentous disruption is seen at the previous disk space distractions. Extensive cord signal abnormality is present compatible with extensive cord injury or infarct. Cord compression is also seen at T7-8 and T11-12 with widened facet joints.
Discussion:
While this case is fairly obvious, some disc space or facet joint distractions may be more subtle, such as slight asymmetric widening of the disc space or facet joint compared to adjacent levels. Particular attention should be paid to a disc space that appears normal in height with osteophytes present that are similar to adjacent levels where the disc spaces are significantly narrowed. Also, an arthrotic appearing facet joint that does not appear significantly narrowed should raise suspicion for a distraction unless asymptomatic with no history of trauma. Distraction injuries are typically unstable due to ligamentous disruption including the anterior and posterior longitudinal ligaments. They result from high velocity mechanisms with axial traction.