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ECR 2019 / C-0081
Magna Cum Laude
Tectorial membrane injury in the acute trauma setting: examining disparities between the adult and paediatric populations
Congress: ECR 2019
Poster No.: C-0081
Type: Scientific Exhibit
Keywords: Neuroradiology spine, Paediatric, Trauma, MR, CT, Localisation
Authors: P. Fiester, E. Soule, P. Natter, D. Rao; Jacksonville, FL/US


A total of 16 patients were identified with acute traumatic injuries involving the TM. Ten adult patients and six pediatric patients had mean ages of 39 and 10 years, respectively. All injuries involved motor vehicles, primarily MVAs and pedestrians struck by motor vehicles. Adult patients were much more likely to undergo surgery to the cervical spine, with 80% receiving fusion of at least one spinal level, followed by halo bracing and/or Miami-J collar (MJC) placement. Length of inpatient stay was considerably longer for adult patients, and 5/10 adult patients had residual neurologic problems ranging from weakness or spasticity of at least one extremity to quadriplegia. All pediatric patients underwent conservative management with immediate halo bracing and/or MJC placement. All pediatric patients achieved good functional outcomes, with no residual craniocervical instability, and no residual neurological deficit related to cervical spine injury.


The most common injury type among adults (90%) was disruption of the TM; 78% of disruptions were in a subclival location near the odontoid, 22% were in a subclival location near the basion. 83% of pediatric patients suffered avulsion of the TM from the clivus (stripping injury) in a retroclival location. All avulsion injuries were associated with REH with mean size of 4.2 mm measured in the largest anterior-posterior dimension. Stretch injuries to the TM were identified in 10% of adults and 17% of pediatric patients (Table 1).



Table 1 Adult patients Paediatric patients
Retroclival avulsion of TM (type 1 injury) 0/10 (0%) 5/6 (83%)
Disrupted TM near basion (type 2a injury) 2/10 (20%) 0/6 (0%)
Disrupted TM near odontoid (type 2b injury) 7/10 (70%) 0/6 (0%)
Thinned TM (type 3 injury) 1/10 (10%) 1/6 (17%)


The most common concurrent ligamentous injuries found in conjunction with TM injury in adults were interspinous ligament tears with incidence of 100%, usually involving C1-C2. followed by apical (90%), aAOM (70%), transverse (50%), LF (40%), unilateral alar (40%), pAOM (30%), ALL (30%), PLL (10%) and bilateral alar (10%). In pediatric patients the most common coincident injury was apical ligament (100%) followed by aAOM (83%), interspinous (67%), unilateral alar (33%), and LF with an incidence of 17%.


In adult patients, coincident C1 fracture occurred 40% of the time and the occipital condyle was fractured in one case. In pediatric patients, one occipital condyle fracture was observed (17%) as well as one C1 fracture (17%); C2 fracture had an incidence of 17%.


Intracranial trauma also documented, the most common finding was sub-arachnoid hemorrhage with an incidence of 60% in adults and 33% in pediatric patients. Subdural hematoma was observed in 40% of adults and 17% of pediatric patients. Grade I diffuse axonal injury (DAI) was seen in 43% of adults who received a brain MRI, grade II in 14%. Cerebral contusion and spinal cord contusion were each seen in adult patients with an incidence of 10%. One pediatric patient had grade II DAI and none had cerebral or spinal cord contusion. 


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