CT Cervical Spine
L: The anatomy of interest in this case is the cervical spine. This is a coronal image obtained from axial CT images by postprocessing. The area of concern is C6–C7. This can be determined by the recognition of the sternoclavicular junction just inferior to the altered anatomy.
CAT: The most disturbing and significant change in anatomy is the transection of the spinal cord. This was not determined for sure by the radiologist, but it almost for certain is due to the severity of the accident. The cervical body of C7 is almost completely destroyed, and multiple bullet fragments remain lodged in the spinal region.
CSB: There are multiple bullet fragments located in the left lateral area of the neck and within the spinal canal. Due to the entrance of the bullet, there is free air located around the bullet fragments. There is mild involvement of C6. C7 appears to be completely shattered.
DC: Since CT is based upon x-ray physics, the detection of multiple dense and bright objects indicates the likelihood of a material with a high atomic number. Given the patient’s history, one can determine that the dense objects are bullet fragments. This trauma came into the University of Nebraska Medical Center less than 2 weeks ago.
C: The cause of this injury was a gunshot wound inflicted upon this 19-year-old man by a 16-year-old boy. The bullet entered the man’s left shoulder, shattering it and then traveling through the cervical spine and transecting the spinal canal. A spinal injury at C6–C7 would cause paralysis from the shoulders down. The diaphragm is controlled in the region of C3–C5, so it is likely that this man will be able to breathe on his own. However, he will be a quadriplegic. Almost 8000 individuals each year suffer from spinal cord injuries. Eighty percent of them are in men aged 16 to 30 years. Almost half of them (44%) are from motor vehicle collisions, 24% are from violent acts, 22% are from falls, and the remaining 8% are from sporting activities, primarily diving. Sadly enough, this young man just became a statistic. During the 6 months following the injury, small improvements in the patient’s condition may be made. Any disabilities that remain after those initial 6 months are likely to be permanent.