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Imaging Final > C-Spine > Flashcards

C-Spine Flashcards

1
Q

Canadian Cervical Spine Rules #1

A

Are there risk factors present?

  • age>65
  • dangerous MOI (fall>1m, axial load to head, high speed MVA)
  • parasthesias in extremities
  • If yes to any –>xray, if no to all ask #2
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2
Q

Canadian Cervical Spine Rules #2

A

Are there low risk factors that allow safe assessment of ROM?

  • Simple rear-end MVA
  • normal sitting posture in exam
  • ambulatory at any time since injury
  • delayed onset neck pain and absence of midline tenderness
  • If no to any = xray, if yes to all ask #3
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3
Q

Canadian Cervical Spine Rule #3

A

Can pt rotate neck 45 deg each direction?

No = xray Yes = proceed with eval

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4
Q

Routine views (3) and Special Views (2)

A 
Routine:
-AP open mouth
-AP lower C-spine
-Lateral
Special:
-R/L oblique (intervert foramen, art process, pedicles)
-Flexion/Extension stress (instability)
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5
Q

AP Open Mouth

A

Best for:

  • occiput condyles
  • atlas (ant arch, post arch, lateral masses)
  • Axis (dens, spinous process)
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6
Q

open mouth measurements (slide 7)

A
  • lateral masses equal width
  • No C1 overhang
  • dens spacing symmetrical
  • C1/C2 jt space equal
  • C2 SP in midline
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7
Q

AP Lower C-spine

A
  • Best for lower 5 cervical vertebrae & upper thoracic
  • remember first disc is at C2/C3
  • radiolucent trachea
  • clavicles magnified
  • good to find cervical ribs
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8
Q

Lateral C-Spine (best for)

A
  • disk height
  • vertebral body height
  • facet margins and spaces
  • Spinous processes
  • atlantodental interface (gap btw anterior surface dens and anterior arch C1)
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9
Q

Lines O’ Life

A
  • should be roughly parallel and the spatial relationship should remain constant
    1. Anterior borders of bodies (ignore osteophytes)
    2. Posterior bodies
    3. Spinolaminar line
    4. Posterior spinous process (C2-C7)
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10
Q

R&L Oblique View

A

Best for: IV foramen size, Articular processes (fx, subluxations), pedicles

  • Can be positioned with anterior neck (RAO/LAO) or post neck (RPO)
  • named for which side foramina are visible
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11
Q

Flexion/Extension Stress Views

A
  • Joints are at end range of voluntary flexion/ext
  • best for showing hypermobility/instability
  • Lines o life should remain smooth and parallel
  • atlantodental interface should remain constant (>3mm = instability)
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12
Q

C1 Burst Fx (Jefferson Fx)

A
  • unilat or bilat fx through anterior and/or post arch
  • axial compression (eg diving)
  • Look at increased dens spacing, overhang
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13
Q

Dens Fx

A
  • associated w other fx of C-spine
  • Type I = avulsion of the tip (alar lig)
  • Type II = fx at junction of dens/body
  • Type III = fx into body
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14
Q

Traumatic Spondylolisthesis C2 (Hangman’s Fx)

A
  • Hangman’s fx: though pars interarticularis (common) or pedicles (rare). usu hyperextension and traction
  • look at LOL
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15
Q

Burst Fx

A
  • like Jefferson, but lower C-spine
  • axial compression, usu with flexion
  • can have posterior displacements of fragments (compromise cord)
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16
Q

Teardrop Fx

A
  • high force neccessary; associated with other C-spine injuries, potentially quite unstable due to loss of ALL
  • avulsion w hyperextension or compression with hyperflexion
  • look at “lines of life”
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17
Q

Articular Pillar Fx

A
  • compressive hyperextension force with a degree of lateral flexion
  • most commonly at C6, usually stable
18
Q

Clay Shoveler’s Fx

A
  • Avulsion fx of spinous process
  • hyperflexion or strong trap contraction
  • stable
  • C6/C7/T1 most common
19
Q

Transverse Process Fx

A
  • uncommon, usually C7

- forced lateral flexion

20
Q

Unilateral Locked facet

A
  • look at overlap of articular surfaces – will be greatly decreased
  • rotation of vertebra will disrupt superimposition of contralateral facet
  • usu problems with ext, rotation/lat flexion to one side – pinching (closed facet position)
21
Q

DDD

A
  • most ppl >60 have DDD
  • decreased disk height
  • osteophytes and spurs around disk margins
  • Schmoral’s nodes
22
Q

DJD

A
  • facet jts (takes up load disc can’t handle)
  • uncovertebral joint
  • often a response to DDD
23
Q

Lateral Spinal Stenosis

A
  • intervertebral recess & foramen
  • bulging/herniated disc (posteriolateral)
  • soft tissue hypertrophy or edema
  • osteophytes
24
Q

Central Stenosis

A
  • Spinal canal narrowing
  • LF hypertrophy, post osteophytes, spondylolisthesis
  • pt usually tolerates flexion better than extension
25
Q

Spondylosis Deformans

A
  • anterior and lateral osteophytes present at disc margins
  • disc height usu normal
  • signs of DDD absent
  • claw like osteophytes
26
Q

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

A
  • > 40, men more common
  • ossification along at least 4 contiguous verterbral bodies
  • no signs DDD/DJD
  • ossification of PLL can occur
  • much like ankylosing spondylitis, but only 4 vert
27
Q

Ankylosing Spondylitis

A
  • SI jt often involved first

- Resembles RA

28
Q

Burst Fx

A
  • like Jefferson, but lower C-spine
  • axial compression, usu with flexion
  • can have posterior displacements of fragments (compromise cord)
29
Q

Teardrop Fx

A
  • high force neccessary; associated with other C-spine injuries, potentially quite unstable due to loss of ALL
  • avulsion w hyperextension or compression with hyperflexion
  • look at “lines of life”
30
Q

Articular Pillar Fx

A
  • compressive hyperextension force with a degree of lateral flexion
  • most commonly at C6, usually stable
31
Q

Clay Shoveler’s Fx

A
  • Avulsion fx of spinous process
  • hyperflexion or strong trap contraction
  • stable
  • C6/C7/T1 most common
32
Q

Transverse Process Fx

A
  • uncommon, usually C7

- forced lateral flexion

33
Q

Unilateral Locked facet

A
  • look at overlap of articular surfaces – will be greatly decreased
  • rotation of vertebra will disrupt superimposition of contralateral facet
  • usu problems with ext, rotation/lat flexion to one side – pinching (closed facet position)
34
Q

DDD

A
  • most ppl >60 have DDD
  • decreased disk height
  • osteophytes and spurs around disk margins
  • Schmoral’s nodes
35
Q

DJD

A
  • facet jts (takes up load disc can’t handle)
  • uncovertebral joint
  • often a response to DDD
36
Q

Lateral Spinal Stenosis

A
  • intervertebral recess & foramen
  • bulging/herniated disc (posteriolateral)
  • soft tissue hypertrophy or edema
  • osteophytes
37
Q

Central Stenosis

A
  • Spinal canal narrowing
  • LF hypertrophy, post osteophytes, spondylolisthesis
  • pt usually tolerates flexion better than extension
38
Q

Spondylosis Deformans

A
  • anterior and lateral osteophytes present at disc margins
  • disc height usu normal
  • signs of DDD absent
  • claw like osteophytes
39
Q

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

A
  • > 40, men more common
  • ossification along at least 4 contiguous verterbral bodies
  • no signs DDD/DJD
  • ossification of PLL can occur
  • much like ankylosing spondylitis, but only 4 vert
40
Q

Ankylosing Spondylitis

A
  • SI jt often involved first

- Resembles RA

Imaging Final (6 decks)

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