- See: Hyperflexion Injuries
- Discussion:
- partial or complete tear of posterior ligaments w/ varying degrees in widening of the interspinous and interlaminar spaces, as well as
subluxation, but not dislocation of Facet Joint;
- hyperflexion sprain injury may include mild anterior subluxation of involved vertebral body;
- this subluxation may be so subtle that it may only be appreciatted on lateral films obtained in flexion;
- that stable injuries to Anterior column include compression frx of < 25% loss of vertebral body height & anteroinferior avulsion frxs
where the fragment width is < 20% of vertebral body width;
- that unstable injuries to Anterior column include compression frxs w/ > 25% loss of ht indicating posterior ligament rupture, and
fractures thru vertebrae;
- frx lines seen on lateral radiographs or CT scans, which extend thru vertebral body centrum in coronal plane represent
anterior column failure;
- Subluxation in RA:
- anterior subluxation occurs as the result of Facet Joint disease and is most commonly seen at C5/6 level, which is level of greatest mobility;
- any level may be affected, however, and it is common to see several levels showing anterior subluxation in a stepwise fashion;
- subaxial involvement in R.A. in less common than atlantoaxial lesions;
- Powers Ratio:
- identifies anterior subluxation and is described as ratio of BC/OA
- BC is distance from basion to midvertical portion of posterior laminar line of the Atlas;
- OA is distance from opisthion to midvertical portion of posterior surface of anterior ring of Atlas;
- if this ratio is greater than 1, anterior subluxation exists
Upper cervical instability in rheumatoid arthritis.