Abstract:The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR ima… Show more
“…The uncinate processes of the lower vertebra lie lateral to the cranial vertebral body (Fig. 2) [21]. Fig.…”
Section: Systematic Review Of Mdct Of Cervical Spine In Trauma—“checkmentioning
confidence: 99%
“…Though axial sections are not very useful to diagnose facet joint dislocation when isotropic sagittal reconstruction is possible, there are several well-described signs of diagnosing facet joint dislocation on axial images in the radiology literature, including the naked facet sign [31], the reverse “hamburger bun” [20] and the “headphones sign” (Fig. 15) [21]. A fracture of the posteroinferior cortex of the rotated vertebral body is frequently seen in patients with unilateral or bilateral facet joint dislocation.…”
Section: Common Injury Patternsmentioning
confidence: 99%
“…24a) is the most commonly used sign to imply the rotation vector; however, on CT, asymmetry of the uncinate process as seen on axial images is one of the most accurate and reliable indicator of the rotation vector (Fig. 15b) [21]. Other useful signs suggestive of rotation injury include: asymmetric disc space with rotated vertebral body in coronal plane and rotation of the fracture fragments.…”
Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or “fingerprints” on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging “pearls” in differentiating “look-alike” lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma.Teaching Points• Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.
“…The uncinate processes of the lower vertebra lie lateral to the cranial vertebral body (Fig. 2) [21]. Fig.…”
Section: Systematic Review Of Mdct Of Cervical Spine In Trauma—“checkmentioning
confidence: 99%
“…Though axial sections are not very useful to diagnose facet joint dislocation when isotropic sagittal reconstruction is possible, there are several well-described signs of diagnosing facet joint dislocation on axial images in the radiology literature, including the naked facet sign [31], the reverse “hamburger bun” [20] and the “headphones sign” (Fig. 15) [21]. A fracture of the posteroinferior cortex of the rotated vertebral body is frequently seen in patients with unilateral or bilateral facet joint dislocation.…”
Section: Common Injury Patternsmentioning
confidence: 99%
“…24a) is the most commonly used sign to imply the rotation vector; however, on CT, asymmetry of the uncinate process as seen on axial images is one of the most accurate and reliable indicator of the rotation vector (Fig. 15b) [21]. Other useful signs suggestive of rotation injury include: asymmetric disc space with rotated vertebral body in coronal plane and rotation of the fracture fragments.…”
Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3–C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or “fingerprints” on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging “pearls” in differentiating “look-alike” lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma.Teaching Points• Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications.
“…The headphones sign is best appreciated on the axial CT scan. The concentric appearance of bilateral uncovertebral joints in a healthy vertebra resembles a pair of headphones on its wearer’s head [ 14 ]. In a fracture or dislocation of the uncovertebral joint, the superior vertebral body is no longer supported by the uncinate process of the inferior vertebra.…”
Section: Introductionmentioning
confidence: 99%
“…Thus, the superior vertebral body is translated anterior to the inferior vertebra, and it rotates towards the normal side. This appearance gives rise to the unilateral positive “headphones sign”, which is commonly associated with UCFJD [ 14 ]. On axial CT scans, the “headphones sign” and “reverse hamburger bun sign” are reliable indicators of cervical facet joint dislocations.…”
Unilateral cervical facet joint dislocation (UCFJD) is the most frequently missed cervical spine injury on plain radiographs. If left untreated, UCFJD can progress to bilateral cervical facet joint dislocation. Given the complexity of cervical facet joint dislocations, radiologists rely on metaphorical signs to identify them on radiographs. The "Bowtie" and "laminar space" signs represent UCFJD on plain radiographs. The "reversed hamburger", "naked facet" and "headphones" signs represent cervical facet joint dislocations on axial cross-sectional imaging. Illustrating these signs in an engaging manner facilitates pattern-based recognition, which can benefit trainees and radiologists. Moreover, pattern-based recognition can be applied to machine learning.
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