C Spine

Question 1

Canadian C spine rules

Answer 1

• Dangerous mechanism
• > 65 +, extremity paresthesia
• Unable to rotation head 45º both ways

Question 2

Best view for C1C2

Answer 2

Odontoid - open mouth

Question 3

Best view for C7-T2

Answer 3

Swimmers

Question 4

Anterior Antlantodental Interval (AADI)

Answer 4

• Lateral view distance between anterior tubercle and dens
• > 2.5mm = instability
• Need Flex or ext lateral views
• Cause = trauma, down syndrome, AS, RA, psoriatic arthritis, Reiter Syndrome

Question 5

George Line

Answer 5

• Lateral view = smooth curve
• Posterior Vertebral bodies should connect
• Flex/Ext views helpful
• Determines anterolisthesis/retrolisthesis
  o Laxity from Fx, dislocation, ligament laxity, DJD

Question 6

Cervical gravity line

Answer 6

• Line from apex to dens

- Should pass 7th cervical vert

Question 7

Paravertebral soft tissue

Answer 7

• C2-4 should not be >7mm in neutral
• C5-7 should not be >20mm
• Shows soft tissue mass, hematoma, neoplasm

Question 8

Spinal fractures

Answer 8

• Most common C1-2, C5-7, T9-L2
• Trauma mostly from MVA
• If CT head then CT spine at the same time

Question 9

C spine signs of instability

Answer 9

• Displacement of vertebrae
• Widening of spaces/facet joints
• Widening/elongation of canal
• Disruption of posterior vertebral line

Question 10

Jeffersons Fx

Answer 10

• Burst Fx ox C1
• MOA blow to vertex of head
• Bilateral fx anterior/posterior arches of C1 + transverse ligament distruption
• View: Open mouth /ondontoid

Question 11

Ondontoid Fx

Answer 11

• Fx of ondontoid process C2
• MOI: Hyperflexion injuries
• Based on stability
• 1 = stable
• 2 = unstable
• 3 = stable

Question 12

Hangman’s fx

Answer 12

• Fx posterior aspects of C2
• MOI: Hyperextension MVA
• Bilateral fx through pedicles of C2
• Spinal cord compromise
• 1 = fx through C2 pedicle, extend between superior and inferior facets
• 2 = Concomitant disruption of C2-3 IVD
• 3 = injury with C2-3 dislocation

Question 13

Teardrop Fx

Answer 13

• Avulsion of anterior vertebral body with posterior subluxation
• Most severe and unstable cervical injury
• Posterior displacement of vertebra into spinal canal, fx of posterior elements, disruption of soft tissues
• ALL tear = leaves fragment

Question 14

Clay shoveler’s Fx

Answer 14

• Fx spinous process of C6 7 T1 T2 (can be one)

- MOI: flexion injury – clayminers, manual labor or weightlifting