C-spine Flashcards
What is the 1st question of the canadian cervical spine rules?
- 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?
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?
Yes: Get x-rays
No: Move on to #2…
What is the 2nd cervical spine rule question?
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?
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?
Yes to all: Ask #3
No to any: Get an x-ray
What is the 3rd cervical spine rule?
- Can the patient rotate the neck 45 degrees each direction?
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?
Yes: Proceed with exam
No: X-rays
What 5 factors should be assessed in the open mouth measurement?
- Lateral masses of equal width?
- Any C1 overhang?
- Dens space symmetrical?
- C1/C2 joint space equal bitlaterally?
- C2 spinous process in midline
Where does the first disk occur in the cervical spine?
At C2 - C3
How will the trachea appear in the AP lower C-spine view?
Radiolucent (black)
Why are the clavicles magnified in the lower C-spine AP view?
- Further from plate
In what view can the facet joints spaces be seen most easily in the c-spine?
- Lateral C-spine
What is the atlanto-dental interface?
Space between dens and anterior border of C1
How should the facets be assessed in the lateral C-spine view?
- Normal joint space
- Good amount of overlap
What may cause a widening of atlantodental interface?
- Long term steroid use
- Down sydrome
What are the lines of life of the c-spine?
- Anterior borders of vertebral bodies (ignore osetophytes)
- Posterior borders of vertebral bodies (ignore osteophytes)
- Spinolaminar line (spinal canal)
- Posterior spinous processes of C2 - C7
How should the lines of life be oriented?
Parallel and equal through length of neck
What is best visualized with the R and L oblique view of the c-spine?
- Intervertebral foramen
- Articular processes
- Pedicles
How can the patient be positioned in oblique views of the c-spine?
Anterior or posterior neck closest to film
Anterior: (RAO and LAO)
Posterior: (RPO and LPO)
What determines if an oblique view is L or R?
The side for which the intervertebral foramen are visualized
What are the lateral flexion and extension stress views of the c-spine?
- Joints at end range of voluntary flexion or extension
What are the stress views used for?
Provoke visualization of instabilities
What should remain constant in the stress positions?
- The lines of life
- The atlantodental interface
How much of an increase of the atlantodental interface indicates instability?
- More than 3mm
Which view provokes an increase in the atlantodental interface?
Flexion
What is a Jefferson fracture?
Through anterior or posterior arch of C1.
What is the mechanism of a Jefferson fracture?
- Axial compression (diving)
How can a Jefferson fracture be assessed?
- Increased Dens spacing
- Overhang
What type of fracture is associated with many other fractures of the c-spine?
- Fracture of the Dens
What are the 3 types of Dens fractures?
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
How can a Dens fracture be assessed?
Look at the spaces
What is a hangman’s fracture?
- Traumatic spondylolesthesis of C2
What are the 2 types of hangman’s fractures? Which is common? Which is rare?
- Through pars interarticularis (common)
- Through Pedicles (rare)
How can a Hangman’s fracture be assessed?
- Lines of life
- Gap between C1 and Occiput and C1 and C2 (should be about the same
What is a burst fracture?
Fracture through the bodies of the lower C-vertebrae
What is the mechanism of injury of a burst fracture?
- Axial compression
- Often combined with flexion
How can the spinal cord become compromised from a burst fracture?
- Posterior displacement of bone fragments
What is a tear drop fracture?
Fracture of anterioinferior aspect of vertebral body
What causes a teardrop fracture? (2 possible causes)
- Avulsion with hyperextension
- Compression with hyperflexion
How is a teardrop fracture assessed?
- Lines of life
How is a sponylolisthesis of the c-spine assessed?
- Lines of life
What is a clay shoveler’s fracture?
- Avulsion fracture of the spinous process
What is the mechanism of injury of a clay shoveler’s fracture?
- Hyperflexion or strong trapezius contraction
Is a Clay Shoveler’s fracture stable or unstable?
- Stable
Which vertebrae are most commonly involved in Clay Shoveler’s fractures?
- C6
- C7
- T1
What is an uncommon c-spine fracture? What is the MOI?
- Transverse process fracture (usually of C7_
- Forced lateral flexion
How does a transverse process fracture present clinically?
- Point tender with history of trauma
Can a patient with a transverse process fracture participate in interventions?
Hell no
How is a unilateral locked facet joint viewed in a radiograph?
- Overlap of articular surfaces greatly decreases (will see both)
Why are both facets seen when one is locked?
Superior vertebra is laterally rotated and side bent on the inferior vertebrae disrupting the superimposition
How common are bilateral locked facets?
Very rare
What are the 3 indicators of DDD in the C-spine?
- Decreased disc height (IVF shrinks)
- Osteophytes and spurs around disk margins
- Schmoral’s nodes (fractures within vertebral body)
What population usually has radiographic findings of DDD of the c-spine?
Asymptomatic people over 60
Is DDD important?
Not especially. Patients movement is the important thing to treat
What imaging technique is required to visualize disc bulges?
MRI
What should be assessed in a disc bulge?
Myelopathy (compression of spinal cord)
What can cause uncovertebral joints?
- Response to increased loading due to DDD
What are 4 causes of lateral spinal stenosis?
- Intervetebral foramen
- Bulging or herniated disk (posteriolateral)
- Soft tissue hypertrophy or edema
- Uncovertebral joint and facet joint osteophytes
What is central stenosis?
- Narrowing of the spinal canal
What can affect the size of the spinal canal?
- Abnormal position or size of any structure bordering the canal
What are 3 specific structures that commonly impinge on the spinal canal?
- Posterior disk margin bulding
- Ligamentum flavum hypertrophy
- Facet joint osteophytes
What is spondylosis deformans?
- Anterior and lateral osteophytes present at disk margins
What is the 1 radiologic signs of spondylosis deformans? What 2 other pathologies are absent?
- Normal disk height
- DDD absent
- Claw like osteophytes
What is diffuse idiopathic skeletal hyperostosis?
- Calcification of ligaments and joints
At what age does DISH typically occur?
Over 40 yo
In what gender is DISH more common?
Men
What are 2 imaging signs of DISH?
- Ossification along at least 4 contiguous vertebrae
- Can happen anteriorly or posteriorly
What pathology does DISH resemble?
Ankylosing spondylitis
What pathology does ankylosing spondylitis resemble besides DISH?
RA.
Which joint is typically involved first in ankylosing spondylitis?
SI
