7b. Trauma Evaluation - Spine Flashcards
what should the predental space be in adults
no more than 3mm
what should the predental space be in children
no more than 5mm
what should C2-3 subluxation be in adults
no more 3mm
what should C2-3 subluxation be in children
no more than 5mm
what should the prevertebral soft tissue measurement in adults at C3
up to 7mm
what should the prevertebral soft tissue measurement in adults at C7
21mm
what should the prevertebral soft tissue measurement in children
1/2 to 2/3 of AP vertebral body
what is the predental space
space infront of peg ant portion of C1
what are the 4 contour lines
AVL
PVL
SLL
PSP
what is the AVL contour line
anterior cortical surfaces of vertebral bodies
what is the PVL contour line
posterior cortical surfaces of vertebral bodies
anterior margin of spinal canal
what is the SLL contour line
spino laminar line
posterior boundary of spinal canal
what is the PSP contour line
posterior spinous process
what are the 4 things to check in a lateral spine xray
alignment = vert body rotation, loss of spinal curves and disrupted contour lines
bones = pathologies
cartilage = predental space, disc spaces, facet joints
soft tissues = prevertebral space
what are the 4 things to check in a AP spine xray
Alignment = Spinous processes line and pedicle lines
Bones = where, which, pathologies?
cartilage = disk space and unconvertable joints
soft tissue = tracheal deviation
what are the 3 osteoligamentous columns of the spine
Anterior
middle
posterior
where is the anterior osteoligamentous columns of the spine
AVL, anterior 2/3 of vertebral body and annulus fibrosis
where is the posterior osteoligamentous columns of the spine
posterior bony complex (posterior arch)
pedicles, laminae, posterior ligamentous complex (supraspinatus ligament, capsule and ligamentum flavum)
where is the middle osteoligamentous columns of the spine
PVL, posterior 1/3 of vertebral body and annulus fibrosis
is it a stable fracture when only one column is involved
yes
is it a stable fracture when 2 non adjacent columns are involved
yes
is it a stable fracture when 3 columns are involved
no
is it a stable fracture when 2 adjacent columns are involved
no
is it a stable fracture when the middle column is involved
no
what are the 4 fractures of the cervical spine
C1
C2
wedge and burst
clay shovellers
what dislocation occurs in the cervical spine
atlanto axial
what is a jeffersons fracture
burst fracture of C1 ring
what causes a jeffersons fracture
axial loading
what is the most common C1 fracture
jeffersons fracture
what happens to the lateral masses in a jeffersons fracture in the peg view
lateral masses move outwards
what happens to the predental space in the lateral image when there is a jeffersons fracture
increased perdental space
is the jeffersons fracture a stable or unstable fracture
unstable
what kind of C1 fracture can result in a normal predental space
posterior neural arch fracture
what is a hangmans fracture
bilateral pedicle/interarticularis fracture of C2
how many types of odontoid fractures are there
3
what is the hangmans fracture caused by
C2 body pushed up secondary to hyperextension, axial loading/rapid deceleration
what is the hangmans fracture
fracture through pedicles of C2
is the hangman fracture stable
no
what is anterolisthesis
slippage of one vertebrae over the others
what is a type 1 odontoid fracture
usually oblique at the upper part/tip of the peg
what is a type 2 odontoid fracture
transverse through base/neck of peg fracture
is type 2 odontoid fracture stable
very unstable
what is a type 3 odontoid fracture
through body of odontoid extending into body of axis
what are wedge fractures caused by
hyperflexion force
what is a wedge fracture
Squashing of other 2 vertebra on either side so affected vert is squashed into point form and loses square shape
compression fracture of the vertebral body compressing the anterior component
what is a burst fracture caused by
hyperflexion
what is a burst fracture
unstable compression fracture through entire vertebral body creating fragments
anterior fragment pushed forwards and posterior fragment pushed backwards into vertebral canal
what is a clay shovellers fracture caused by
hyperflexion and rotation
where does the clay shovellers fracture occur
C7/6 spinous process
what is a sign of clay shovellers fracture in the AP image
ghosting of spinous process in Ap view
what holds the dens against the anterior atlas
transverse ligament attaches media sides lateral masses
what could transverse ligament damage result in
movement potential neurological catastrophe
what is a chance fracture and where does it occur
horizontal fracture through the spinous process, laminar, pedicles and vertebral body
all 3 columns, lower spine
what are the 3 important things to assess for a burst fracture of C1
joint spaces on both sides should be equal and symmetrical
lateral masses of C1 should align with C2
increased predental space is seen inconsistently on lateral image
what is a chance fracture caused by
flexion/extension injury
