Male, 16 months old, with neck stiffness status post fall. Evaluate for ligamentous injury. The prevertebral space is significantly thickened suggestive of soft tissue edema and/or tracking fluid/blood product. The anterior atlanto-occipital ligament is not visualized. The anterior atlanto-axial ligament is thickened and not obviously adherent to the C2 vertebral body. The apical ligament is not well visualized and the soft tissues above the odontoid tip are edematous. The tectorial membrane appears to be intact.Below the level of C2, no injury to the anterior longitudinal ligament is suspected. The intervertebral disc spaces are intact. No injury to the posterior longitudinal ligament, posterior atlanto-occipital and atlantoaxial ligaments, the supraspinous ligament or the nuchal ligament is suspected.No significant compromise of the spinal canal or neural foramina is seen. The spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of cord edema or cord contusion is seen. No epidural collections are detected.
Findings are seen compatible with ligamentous injury at the anterior cranio-cervical junction. Specifically, the anterior atlanto-occipital and atlanto-axial ligaments appear to be strained or frankly torn. The apical ligament is also not well seen and may be injured.The anterior and posterior longitudinal ligaments otherwise appear to be intact and there is no evidence to suggest traumatic disc injury. Likewise, the posterior ligamentous structures are intact. No evidence of traumatic spinal cord injury is demonstrated.