Hyperextension Injuries

Hyperextension injuries include dislocations, fracture-dislocations and laminar fractures. These are commonly seen in younger patients as a result of motor vehicle accidents and in elderly patients with cervical spondylosis. They usually result from a backward force to the cervical spine as a result of an impact transmitted after an injury to the mandible, face or forehead. This then throws the head and cervical spine into hyperextension. Clinically, patients may not present with any neurological deficits or, in the case of the elderly patient with cervical stenosis that falls forward, they may present with the central cord syndrome.

Due to the fact that the cervical spine might return to its normal alignment after posterior dislocation, the radiological diagnosis might be difficult to obtain. Posterior laminar fractures with avulsion of the anterior longitudinal ligament and retrolisthesis of the vertebral body can be observed. Other signs include pre-vertebral soft tissue swelling, widening or asymmetry of the disrupted intervertebral disc with a small vacuum sign, fractures of the vertebral end plates or small avulsion fractures of the anterior inferior margin of the vertebral body.

In the case of hyperextension dislocation and hyperextension fracture-dislocation, both anterior and posterior longitudinal ligaments may be disrupted. Disruption of the intervertebral disc and displacement of the vertebra above the disc posteriorly may also be appreciated. This can cause compression of the spinal cord against the posterior arch of the spine. Patients can present with focal neurological deficits or complete quadriplegia. Sometimes, abrasions or soft tissue injury to the face and forehead, clinical findings consistent with the central cord syndrome and pre-vertebral soft tissue swelling associated with a normally aligned cervical spine on lateral radiographs are the clues to these types of injury. These are unstable injuries that need surgical stabilization, usually with an anterior approach procedure.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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