Very unfortunate case of a young patient, who was crossing the street on a bike when he was struck by an SUV. The patient had brief loss of consciousness with decorticate posturing. Following that, he had reported no sensation and total weakness from the waist down, with physical exam showing total sensory and motor loss from the nipple level (T4) and below.
CT shows no fractures but some abnormal amount of gas/air in the back of the spinal canal at C7-T1.
MR shows complete transection of the spinal cord with 0.5 cm gap at T3 - goes well with the physical exam finding. There is a dorsal epidural hematoma. There was also disruption of the anterior longitudinal ligament, posterior longitudinal ligament, and ligamentum flavum at T3 (not shown).
What probably happened was that instead of a fracture, the traumatic force went through the ligaments maintaining spinal alignment, causing the spine at the T3 level to dislocate and shear, cutting through the spinal cord. By the time imaging was done, the bones relocated to their normal position, but the damage had been done.
