C spine Flashcards
canadian cervical spine rules
100% sensitive
43% specific
three questions
1 canadian rules
- *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
2 canadian rules
- *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
3 canadian rules
- *if NO –> radiographs
- *if YES –> proceed with tx
Is the patient able to rotate head to 45 degrees each way??
routine views
AP open mouth
AP lower C spine
Lateral
special views
R and L obliques
- intervertebral foramen
- articular processes
- pedicles
Flexion and Extension stress
-instability
AP open mouth is best for:
occiput condyles
atlas
- anterior arch
- posterior arch
- lateral masses
axis:
- dens
- spinous process
open mouth measurements
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)
AP open mouth outline:
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
AP lower C-spine
best for 5 cervical vertebrae, upper thoracic
when counting remember first disk is at C2/C3!!!
radiolucent trachea
clavicles magnified (further distance from plate)
AP lower c- spine outline
C3-C7:
- vertebral bodies
- spinous processes
- pedicles
trachea
clavicles
first rib
lateral c-spine best for:
disk height
- different cervical levels
- anterior posterior
vertebral body height
facet margins and spaces-
- good overlap
- radiologic joint space
spinous processes
atlantodental interface
lines of life
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
lateral c-spine outline
atlantodental interface
C1 posterior arch
C2-7
- vertebral bodies
- articular pillar with superior and inferior facets
- lamina
- spinous process
4 signs of life
R & L oblique view best for:
- 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
oblique view outline
C1-6
- ant and post arch C1
- atlantodental interface
- vertebral bodies
- pedicles
- spinous process
- IV foramen (be careful)
first rib
clavicle
lateral flexion and extension stress views
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)
instabilities
C6 SP fx
compression fracture anterior body C6
ligament disruption C6/c7 interspace
hyperflexion sprain posterior ligament complex C5/C6
C1 burst fracture: Jefferson fracture
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
fractures of the dens
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
traumatic spondylolesthesis C2
Hangman’s fracture:
- through pars interarticularis (common) or pedicals (rare)
- usually hyperextension and traction
look at lines of life
burst fractures
-like Jefferson, but in lower C-spine
axial compression, often with flexion
can have posterior displacements of fragments
-compromise cord
teardrop fractures
high force necessary; associated with other c-spine injuries- potentially quite unstable
avulsion with hyperextension
compression with hyperflexion
look at “lines of life”
articular pillar fractures
spondylolisthesis
-look at lines of life
clay shoveler’s fracture
hyper flexion or strong trap contraction
fractures the SP
stable
C6, C7, T1 most common
transverse process fractures
uncommon- usually C7
forced lateral flexion
unilateral locked facet
look at overlap of articular surfaces
-will be greatly decreased
rotation of vertebra will disrupt superimposition of contralateral facet
slide 27
bilateral locked facets
slide 28
degenerative disk disease in cervical spine
most asymptomatic people >60 have radiographic changes indicating degeneration of disks
- decreased disk height
- osteophytes and spurs around disk margins
- Schmoral’s nodes
schmoral’s node
protrusion of the cartilage of the intervertebral disk through the vertebral body
disk bulges
MRI needed to visualize
lateral spinal stenosis
intervertebral recess and foramen
bulging or herniated disk (posteriorlateral)
soft tissue hypertrophy or edema
-
central spinal stenosis
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
spinal canal is narrowed by:
posterior disk margin (bulges)
ligamentum flavum (hypertrophy)
facet joints (osteophytes)
spondylosis deformans
anterior and lateral osteophytes present at disk margins
- disk height is usually normal
- signs of DDD absent
- claw like osteophytes
diffuse idiopathic skeletal hyperostosis (DISH)
> 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
ankylosing spondylitis
SI joint often first involved
radiographically resembles RA
