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Diagnostic Imaging 2 > C spine > Flashcards

C spine Flashcards

1
Q

canadian cervical spine rules

A

100% sensitive
43% specific

three questions

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2
Q

1 canadian rules

A
  • *if YES to any –> radiographs
  • *if NO to all –> ask #2

age >65

dangerous MOI

  • fall from >1m or 5 stairs
  • axial load to head (diving)
  • high speed MVA (>100 km/h)
  • motorized recreational vehicle
  • bicycle collision

paresthesias in extremities

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3
Q

2 canadian rules

A
  • *if NO to any –>radiographs
  • *if YES to all –> ask #3

simple rear-end MVA

  • normal sitting posture in exam
  • -ambulatory at any time since injury
  • delayed onset neck pain and absence of midline tenderness
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4
Q

3 canadian rules

A
  • *if NO –> radiographs
  • *if YES –> proceed with tx

Is the patient able to rotate head to 45 degrees each way??

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5
Q

routine views

A

AP open mouth
AP lower C spine
Lateral

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6
Q

special views

A

R and L obliques

  • intervertebral foramen
  • articular processes
  • pedicles

Flexion and Extension stress
-instability

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7
Q

AP open mouth is best for:

A

occiput condyles

atlas

  • anterior arch
  • posterior arch
  • lateral masses

axis:

  • dens
  • spinous process
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8
Q

open mouth measurements

A

lateral masses equal width (a-a)

no C1 overhand (b & b)

dens space symmetrical (c-c)

c1/c2 joint space equal (d-d)

C2 SP in midline (e)

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9
Q

AP open mouth outline:

A

occiputal condyles

C1:

  • lateral masses
  • transverse processes
  • ant and post arches

C2:

  • dens and body
  • superior art facet
  • spinous process

Measure:

  • lateral masses equal width, no C1 overhand
  • dens space symmetrical
  • c1/c2 joint space equal
  • C2 spinous process in midline
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10
Q

AP lower C-spine

A

best for 5 cervical vertebrae, upper thoracic

when counting remember first disk is at C2/C3!!!

radiolucent trachea

clavicles magnified (further distance from plate)

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11
Q

AP lower c- spine outline

A

C3-C7:

  • vertebral bodies
  • spinous processes
  • pedicles

trachea

clavicles

first rib

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12
Q

lateral c-spine best for:

A

disk height

  • different cervical levels
  • anterior posterior

vertebral body height

facet margins and spaces-

  • good overlap
  • radiologic joint space

spinous processes

atlantodental interface

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13
Q

lines of life

A

four lines drawn. should be roughly parallel and the spatial relationship should remain constant

1: anterior borders of the vertebral bodies (ignore osteophytes)
2: posterior border of vertebral bodies (ignore osteophytes)
3: spinolaminar line (on top of the spinal canal-or the root of the spinous process)
4: posterior spinous processes C2-7

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14
Q

lateral c-spine outline

A

atlantodental interface

C1 posterior arch

C2-7

  • vertebral bodies
  • articular pillar with superior and inferior facets
  • lamina
  • spinous process

4 signs of life

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15
Q

R & L oblique view best for:

A
  • IV forament size
  • articular processes (fractures, subluxations)
  • pedicles

can be positioned with anterior neck (R or L ant oblique) or posterior neck (RPO & LPO) closest to film

in use, the view is named for which side (R or L) intervertebral foramen are visualized

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16
Q

oblique view outline

A

C1-6

  • ant and post arch C1
  • atlantodental interface
  • vertebral bodies
  • pedicles
  • spinous process
  • IV foramen (be careful)

first rib

clavicle

17
Q

lateral flexion and extension stress views

A

joints are at end range of voluntary flexion or extension

best for demonstrating instabilities

“lines of life” should remain smooth and parallel

atlantodental interface should remain constant (1-3 mm indicates instability)

18
Q

instabilities

A

C6 SP fx

compression fracture anterior body C6

ligament disruption C6/c7 interspace

hyperflexion sprain posterior ligament complex C5/C6

19
Q

C1 burst fracture: Jefferson fracture

A

unilateral or bilateral fracture through the anterior and/or posterior* arch
-caused by axial compression that forces the occiput onto the atlas (diving into shallow head first, MVAs)

look at:

  • dens spacing (increased)
  • overhand
20
Q

fractures of the dens

A

high association with other fractures of the C-spine

  • type I: avulsion fracture of the tip (alar or apical log stress)
  • type II: fracture at junction of dens to body (most common and most difficult to heal)
  • type III: fracture into the body (heals readily)

look at spaces

21
Q

traumatic spondylolesthesis C2

A

Hangman’s fracture:

  • through pars interarticularis (common) or pedicals (rare)
  • usually hyperextension and traction

look at lines of life

22
Q

burst fractures

A

-like Jefferson, but in lower C-spine

axial compression, often with flexion

can have posterior displacements of fragments
-compromise cord

23
Q

teardrop fractures

A

high force necessary; associated with other c-spine injuries- potentially quite unstable

avulsion with hyperextension

compression with hyperflexion

look at “lines of life”

24
Q

articular pillar fractures

A

spondylolisthesis

-look at lines of life

25
Q

clay shoveler’s fracture

A

hyper flexion or strong trap contraction
fractures the SP

stable

C6, C7, T1 most common

26
Q

transverse process fractures

A

uncommon- usually C7

forced lateral flexion

27
Q

unilateral locked facet

A

look at overlap of articular surfaces
-will be greatly decreased

rotation of vertebra will disrupt superimposition of contralateral facet

slide 27

28
Q

bilateral locked facets

A

slide 28

29
Q

degenerative disk disease in cervical spine

A

most asymptomatic people >60 have radiographic changes indicating degeneration of disks

  • decreased disk height
  • osteophytes and spurs around disk margins
  • Schmoral’s nodes
30
Q

schmoral’s node

A

protrusion of the cartilage of the intervertebral disk through the vertebral body

31
Q

disk bulges

A

MRI needed to visualize

32
Q

lateral spinal stenosis

A

intervertebral recess and foramen

bulging or herniated disk (posteriorlateral)

soft tissue hypertrophy or edema

-

33
Q

central spinal stenosis

A

spinal canal:

  • normally 16-17 mm wide in mid cervical region
  • size can be affected by abnormal position or size of any structure bordering the canal
34
Q

spinal canal is narrowed by:

A

posterior disk margin (bulges)

ligamentum flavum (hypertrophy)

facet joints (osteophytes)

35
Q

spondylosis deformans

A

anterior and lateral osteophytes present at disk margins

  • disk height is usually normal
  • signs of DDD absent
  • claw like osteophytes
36
Q

diffuse idiopathic skeletal hyperostosis (DISH)

A

> 40 y/o
men>women

imaging signs:

  • ossification along at least 4 contiguous vertebral bodies
  • no signs of DDD
  • no signs of DJD

ossification of post long ligament can occur

37
Q

ankylosing spondylitis

A

SI joint often first involved

radiographically resembles RA

Diagnostic Imaging 2 (6 decks)

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