2.4 Cervical Spine SD Diagnosis

Question 1

How many cervical vertebrae are there? Atypical? Typical?

Answer 1

7 total:
Atypical: Atlas (C1), Axis (C2), and C7
Typical: C3-C6

Question 2

Where do the nerves exit in cervical vertebrae? Thoracic and lumbar?

Answer 2

cervical: ABOVE the vertebral body

thoracic and lumbar: BELOW

Question 3

Describe the atlas

Answer 3

• No vertebral body
• rotates around the dens of C2
• bounded anteriorly on the dens by anterior arch and posteriorly by transverse atlantal ligament (part of cruciform ligaments)

Question 4

Describe the axis

Answer 4

vertebral body of C2 extends superiorly to form the dens (odontoid process)

Question 5

What indicates a C-spine lateral view?

Answer 5

Emergency: trauma, MVA

Office use: chronic neck or head pain despite conservative treatment; neurologic changes

Question 6

What do you look for in a C-spine lateral view?

Answer 6

alignment of anterior vertebral line, posterior vertebral line, spinal laminar line, and posterior spinous process line

Question 7

What do arthritic changes look like on an xray?

Answer 7

increased white (bone), spurring, abnormal growth

Question 8

What is hangman’s fracture?

Answer 8

anterior displacement of body of C2, fractured vertebral arch of C2

Question 9

What do you look for on AP radiograph of C-spine?

Answer 9

superior and inferior endplates, spinous processes, lateral masses

Question 10

What should the distance of spinous processes on AP radiograph of C-spine?

Answer 10

equal, no space should be 50% wider than the one immediately above or below it. If it is, characteristic of an anterior cervical dislocation.

Question 11

Why do an open mouth radiograph?

Answer 11

This view enables assessment of C1 and C3 (fractures of odontoid process, however, are movre visible on the lateral projection due to subsequent anterior/posterior displacement)
Lateral masses of C1 should not extend wider than the lateral masses of C2. BURST FRACTURE

Question 12

What does the 45 degree oblique view show?

Answer 12

intervertebral foramina, presence of osteophyte encroachment in spondylosis (OA)

Question 13

OA joint

Answer 13

occiput-C1
major motions: flexion and extension - more sagittal plane motion
minor motions: sidebending, rotation, due to shape type I like

Question 14

AA joint

Answer 14

C1-C2
primary motion is rotation about the dens
almost NO sidebending or flexion/extension

Question 15

C2-C7 rotation and sidebending

Answer 15

usually occur in the same direction due to uncinate process - type 2 like

Question 16

C spine ROM values

Answer 16

flexion 45-90
extension 45-90
sidebending 45
rotation 70-90

Question 17

ST cervical indications and contraindications

Answer 17

indications: cervical SD with significant ST component
contraindications: fractures, open wounds or surgical site, infection, DVT, coagulopathy, neoplasm

Question 18

HVLA, ART indications and contraindications

Answer 18

indications: cervical SD with ROM restriction (hard firm end feel)
contraindications: advanced RA; Down’s syndrome; vertebral/carotid artery disease; inflammatory arthritidies; malignancy; acute radiculopathy; Klippel-Feil syndrome; Chiari malformation; achondroplastic dwarfism

Question 19

MET or Stills indications and contraindications

Answer 19

indications: Cervical SD
contraindications: undiagnosed joint swelling; severe osteoporosis; neoplasm; infection; hematoma; RA; fracture; dislocation