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Diagnostic Imaging > C-spine > Flashcards

C-spine Flashcards

1
Q

What is the 1st question of the canadian cervical spine rules?

A
  • Older than 65?

Dangerous mechanism of injury?:

  • Fall from >1m or 5 stairs
  • Axial load to head
  • High speed MVA (100km/h)
  • Motorized recreational vehicle
  • Bicycle collision
  • Parathesias in extremities?
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2
Q

If a patient answers yes to any of the first c-spine rules, what is the course of action? What if the patient answers no?

A

Yes: Get x-rays
No: Move on to #2…

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3
Q

What is the 2nd cervical spine rule question?

A

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

  • Simple rear-end motor vehicle accident?
  • 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

If a patient answers yes to all of the #2 questions, what is the course of action? What if a patient answers no to any of the questions?

A

Yes to all: Ask #3

No to any: Get an x-ray

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5
Q

What is the 3rd cervical spine rule?

A
  • Can the patient rotate the neck 45 degrees each direction?
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6
Q

If the patient answers no to the 3rd question, what is the course of action? If the patient answers yes, what is the course of action?

A

Yes: Proceed with exam
No: X-rays

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7
Q

What 5 factors should be assessed in the open mouth measurement?

A
  • Lateral masses of equal width?
  • Any C1 overhang?
  • Dens space symmetrical?
  • C1/C2 joint space equal bitlaterally?
  • C2 spinous process in midline
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8
Q

Where does the first disk occur in the cervical spine?

A

At C2 - C3

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9
Q

How will the trachea appear in the AP lower C-spine view?

A

Radiolucent (black)

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10
Q

Why are the clavicles magnified in the lower C-spine AP view?

A
  • Further from plate
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11
Q

In what view can the facet joints spaces be seen most easily in the c-spine?

A
  • Lateral C-spine
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12
Q

What is the atlanto-dental interface?

A

Space between dens and anterior border of C1

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13
Q

How should the facets be assessed in the lateral C-spine view?

A
  • Normal joint space

- Good amount of overlap

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14
Q

What may cause a widening of atlantodental interface?

A
  • Long term steroid use

- Down sydrome

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15
Q

What are the lines of life of the c-spine?

A
  • Anterior borders of vertebral bodies (ignore osetophytes)
  • Posterior borders of vertebral bodies (ignore osteophytes)
  • Spinolaminar line (spinal canal)
  • Posterior spinous processes of C2 - C7
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16
Q

How should the lines of life be oriented?

A

Parallel and equal through length of neck

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17
Q

What is best visualized with the R and L oblique view of the c-spine?

A
  • Intervertebral foramen
  • Articular processes
  • Pedicles
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18
Q

How can the patient be positioned in oblique views of the c-spine?

A

Anterior or posterior neck closest to film
Anterior: (RAO and LAO)
Posterior: (RPO and LPO)

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19
Q

What determines if an oblique view is L or R?

A

The side for which the intervertebral foramen are visualized

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20
Q

What are the lateral flexion and extension stress views of the c-spine?

A
  • Joints at end range of voluntary flexion or extension
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21
Q

What are the stress views used for?

A

Provoke visualization of instabilities

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22
Q

What should remain constant in the stress positions?

A
  • The lines of life

- The atlantodental interface

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23
Q

How much of an increase of the atlantodental interface indicates instability?

A
  • More than 3mm
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24
Q

Which view provokes an increase in the atlantodental interface?

A

Flexion

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25
Q

What is a Jefferson fracture?

A

Through anterior or posterior arch of C1.

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26
Q

What is the mechanism of a Jefferson fracture?

A
  • Axial compression (diving)
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27
Q

How can a Jefferson fracture be assessed?

A
  • Increased Dens spacing

- Overhang

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28
Q

What type of fracture is associated with many other fractures of the c-spine?

A
  • Fracture of the Dens
29
Q

What are the 3 types of Dens fractures?

A

Type I: Avulsion of the tip due to the alar ligament
Type II: At junction of dens and body
Type III: Fracture into the body

30
Q

How can a Dens fracture be assessed?

A

Look at the spaces

31
Q

What is a hangman’s fracture?

A
  • Traumatic spondylolesthesis of C2
32
Q

What are the 2 types of hangman’s fractures? Which is common? Which is rare?

A
  • Through pars interarticularis (common)

- Through Pedicles (rare)

33
Q

How can a Hangman’s fracture be assessed?

A
  • Lines of life

- Gap between C1 and Occiput and C1 and C2 (should be about the same

34
Q

What is a burst fracture?

A

Fracture through the bodies of the lower C-vertebrae

35
Q

What is the mechanism of injury of a burst fracture?

A
  • Axial compression

- Often combined with flexion

36
Q

How can the spinal cord become compromised from a burst fracture?

A
  • Posterior displacement of bone fragments
37
Q

What is a tear drop fracture?

A

Fracture of anterioinferior aspect of vertebral body

38
Q

What causes a teardrop fracture? (2 possible causes)

A
  • Avulsion with hyperextension

- Compression with hyperflexion

39
Q

How is a teardrop fracture assessed?

A
  • Lines of life
40
Q

How is a sponylolisthesis of the c-spine assessed?

A
  • Lines of life
41
Q

What is a clay shoveler’s fracture?

A
  • Avulsion fracture of the spinous process
42
Q

What is the mechanism of injury of a clay shoveler’s fracture?

A
  • Hyperflexion or strong trapezius contraction
43
Q

Is a Clay Shoveler’s fracture stable or unstable?

A
  • Stable
44
Q

Which vertebrae are most commonly involved in Clay Shoveler’s fractures?

A
  • C6
  • C7
  • T1
45
Q

What is an uncommon c-spine fracture? What is the MOI?

A
  • Transverse process fracture (usually of C7_

- Forced lateral flexion

46
Q

How does a transverse process fracture present clinically?

A
  • Point tender with history of trauma
47
Q

Can a patient with a transverse process fracture participate in interventions?

A

Hell no

48
Q

How is a unilateral locked facet joint viewed in a radiograph?

A
  • Overlap of articular surfaces greatly decreases (will see both)
49
Q

Why are both facets seen when one is locked?

A

Superior vertebra is laterally rotated and side bent on the inferior vertebrae disrupting the superimposition

50
Q

How common are bilateral locked facets?

A

Very rare

51
Q

What are the 3 indicators of DDD in the C-spine?

A
  • Decreased disc height (IVF shrinks)
  • Osteophytes and spurs around disk margins
  • Schmoral’s nodes (fractures within vertebral body)
52
Q

What population usually has radiographic findings of DDD of the c-spine?

A

Asymptomatic people over 60

53
Q

Is DDD important?

A

Not especially. Patients movement is the important thing to treat

54
Q

What imaging technique is required to visualize disc bulges?

A

MRI

55
Q

What should be assessed in a disc bulge?

A

Myelopathy (compression of spinal cord)

56
Q

What can cause uncovertebral joints?

A
  • Response to increased loading due to DDD
57
Q

What are 4 causes of lateral spinal stenosis?

A
  • Intervetebral foramen
  • Bulging or herniated disk (posteriolateral)
  • Soft tissue hypertrophy or edema
  • Uncovertebral joint and facet joint osteophytes
58
Q

What is central stenosis?

A
  • Narrowing of the spinal canal
59
Q

What can affect the size of the spinal canal?

A
  • Abnormal position or size of any structure bordering the canal
60
Q

What are 3 specific structures that commonly impinge on the spinal canal?

A
  • Posterior disk margin bulding
  • Ligamentum flavum hypertrophy
  • Facet joint osteophytes
61
Q

What is spondylosis deformans?

A
  • Anterior and lateral osteophytes present at disk margins
62
Q

What is the 1 radiologic signs of spondylosis deformans? What 2 other pathologies are absent?

A
  • Normal disk height
  • DDD absent
  • Claw like osteophytes
63
Q

What is diffuse idiopathic skeletal hyperostosis?

A
  • Calcification of ligaments and joints
64
Q

At what age does DISH typically occur?

A

Over 40 yo

65
Q

In what gender is DISH more common?

A

Men

66
Q

What are 2 imaging signs of DISH?

A
  • Ossification along at least 4 contiguous vertebrae

- Can happen anteriorly or posteriorly

67
Q

What pathology does DISH resemble?

A

Ankylosing spondylitis

68
Q

What pathology does ankylosing spondylitis resemble besides DISH?

A

RA.

69
Q

Which joint is typically involved first in ankylosing spondylitis?

A

SI

Diagnostic Imaging (14 decks)

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