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
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
3
Q
Canadian Cervical Spine Rule #3
A
Can pt rotate neck 45 deg each direction?
No = xray Yes = proceed with eval
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)
5
Q
AP Open Mouth
A
Best for:
- occiput condyles
- atlas (ant arch, post arch, lateral masses)
- Axis (dens, spinous process)
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
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
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)
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)
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
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)
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
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
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
15
Q
Burst Fx
A
- like Jefferson, but lower C-spine
- axial compression, usu with flexion
- can have posterior displacements of fragments (compromise cord)
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”
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
