C-spine Flashcards
What are the bones of the vertebral column
C: 7 vertebrae, 8 spinal nerves T: 12 vertebrae and nerves L: 5 vertebrae and nerves, cauda equina S: 5 fused, SI joints C: 5 fused
Briefly describe the anatomy of a vertebrae
Vertebral body and arch pedicle, lamina Vertebral foramen (spinal cord passes through here) Spinous process Transverse processes Articular facets (T have costal facets)
How does the vertebral column move
lateral flexion
rotation
flexion extension
How are C1 and C different
There is no intervertebral disc between C1 and C2
Dens (C2) extends upwards to allow C1 to rotate
What are the intervertebral discs
between adjacent vertebrae from C2-Lumbosacral junction
Numbered as vertebral body above it
Has a fibrous ring around it (fibrocartilage), and a Pulpous nucleus in the center (high water content, slightly posterior, shape altered by movement)
What are examples of disc problems
Degeneration (+/- w/ osteophyte formation)
Bulging (prolapse)
Herniated (extrusion)
Sequestration (herniated and leaking away)
Thinning
What are the layers of the spinal column (SF to Deep)
Epidural space Dura mater Subdural space Arachnoid mater Subarachnoid space Pia mater
What do different spinal nerve roots innervate
Ventral root: Myotomes
Dorsal root: Dermatomes
(C7 dermatome is the middle finger)
(S#-5 is perineal/genital area)
Briefly explain the brachial plexus
C5-T1 nerve roots lead into;
Superior, Middle, and Inferior trunks lead into;
3 anterior and 3 posterior divisions lead into;
Lateral, Posterior, and Medial cords lead into;
Musculocutaneous, Axillary, Radial, Median, and Ulnar nerves
What is the difference between a sprain and a strain
Sprain: Ligament injury (bone to bone)
Strain: Tendon injury (muscle to bone)
What is a cervical strain/sprain
Usually a combined injury of ligamentous structures and cervical musculature
Causes of a cervical strain/sprain are
forced movement past end range
sudden contraction
violent high velocity movement
How does a C-sprain/strain present
Non-radicular, non-focal neck pain anywhere from base of skull to cervicothoracic junction
Neck stiffness, limited ROM
+/- Cervicogenic HA pattern
On C-sprain/strain PE you may find
ttp over involved muscle, facet joint, or transverse process
NO pain w/ axial loading
usually normal neuro exam
In what non-trauma case would you order a C spine XR
50+ w/ new onset Sx
Constitutional Sx (fever, wt loss, chills)
mod-severe neck pain >6 wks
progressive neuro findings
infectious risk (IVDU, immunosuppressed)
Hx of malignancy
In what trauma cases would you order a C spine XR
can use Nexus low risk criteria, but Canadian C spine rules are preferred (for alert and stable trauma patients where C spine injury is a concern) 3 qualifying questions:
- High risk factors that mandate XR?
- No low risk factors that allow safe assessment of ROM?
- able to actively rotate neck 45” L&R?
Describe high risk factors present that would rule in C spine XR
65+
Dangerous mechanism of injury
Paresthesias in extremities
Describe low risk factors that would allow ROM testing and exclude need for XR
Simple rear end MVC Sitting position in ED Walking at ay time Delayed onset neck pain NO midline C spine ttp (if they can rotate neck actively, do not need XR)
Why is delayed onset neck pain not a worry
BC s/p MVC, pain will be worse on Day 2 and 3 than Day of accident if the MOI is musculoskeletal
Fractures hurt the same day!
When viewing a C spine XR that shows the dens, what must you look out for
A straight line through the dens! This is normal, the bottom of the two front teeth, but most mistake it for a Fx
There are never straight lines in anatomy!
What type of pain points you to different C spine injury
Sharp pain: Muscle or ligament sprain
Tightness followed by pain: Muscle spasm
What type of pain points you to different C spine injury
Sharp pain: Muscle or ligament sprain
Tightness followed by pain: Muscle spasm
