Incomplete cervical spinal cord injury from trauma

16-year-old man involved in a head-on motor vehicle collision. At presentation, incomplete cord injury was documented (ASIA grade B) on neurologic examination. Cervical spine CT in sagittal (A) and axial (B) planes show burst fracture of C5 vertebrae (arrow) with approximately 50% loss of anterior vertebral body height and narrowing of the central spinal canal (double arrow) secondary to fracture retropulsion. Mild widening of C4 to C5 interspinous space is also seen. Cervical spine MRI with sagittal T2 sequences (C) show swelling and hyperintense signal within the spinal cord (bracket) from segmental C4 to C6 levels, consistent with cord contusion. Hyperintense signal is also seen within the C5 vertebral body (thick arrow) and prevertebral space (dashed arrow) from C2 to C5 consistent with bone contusion from burst fracture and edema from tear of the anterior longitudinal ligaments, respectively. T2*-GRE sequences in sagittal (D) and axial (E) planes demonstrate small foci of hypointense signal (arrowheads) within the central cord, consistent with hematomyelia. Panels B and E were obtained at the same level and show the superior detection of the C5 vertebral body and right laminar fractures on CT.