Fig. 12

Hyperflexion distraction injury. Mid-sagittal CT image of the cervical spine shows focal kyphosis with posterior disc space widening at C4–C5 (short arrow). Mild anterolisthesis of C4 over C5 is seen suggested by the disrupted posterior vertebral line (black lines). The spinolaminar line is also disrupted with at C4–C5 with anterior displacement of C4 spinolaminar junction (white lines). Widening of the C4–C5 interlaminar/interspinous space (long arrow) is noted. Combination of this pattern of injury is highly suggestive of hyperflexion distraction injury and the facet joint should be carefully evaluated on lateral parasagittal images for possible distraction, subluxation and dislocation (shown in Fig. 13)