C-Spine Comp Flashcards
What does the spinal canal contain?
Spinal cord and CSF
Parts of the spinal cord?
- Midbrain
- Pons
- Medulla oblongata
Where does the spinal cord end?
L1 (conus medullaris)
2 primary curves of the spine?
- Thoracic
2. Sacral
2 compensatory curves of the spine?
- Cervical (from baby lifting head and sitting up)
2. Lumbar (from baby walking)
Another word for kyphosis?
Humpback
Another word for lordosis?
Swayback
What pass through the intervertebral foramina?
Blood vessels/nerves
What are the intervertebral disk spaces for?
Absorbing shock
Parts of an intervertebral disk?
- Annulus fibrosis (outside)
- Nucelus pulposus (inside)
Things specific to C-spine vertebrae?
- transverse foramina
- bifid spinous processes
- overlapping vertebral bodies
C1 AKA?
Atlas
C2 AKA?
Axis
What are the articular pillars of C1 called?
Lateral masses
What degree of rotation is needed to see the foramina?
45 degrees, side farthest from the IR
What degree of rotation is needed to see the zygapophyseal joints?
90 degrees
What are the lateral masses for?
- assist in rotation
- support the weight of the head
Occipitoatlantal joint classification
- synovial
- diarthrodial
- ellipsoid/condyloid
C1-C2 R/L atlantoaxial joints (lateral)
- synovial
- diarthrodial
- plane/gliding
C1-C2 medial atlantoaxial joint (dens) joint classification
- synovial
- diarthrodial
- pivot/trochoid
Intervertebral disk space joint classification?
- synovial
- amphiarthrodial
- cartilaginous/symphysis
Zygapophyseal joint classification
- synovial
- diarthrodial
- plane/gliding
T spine foramina seen at what degree of rotation?
90 degrees
T Spine zygapophyseal joints seen at what degree of rotation?
70-75 degrees
Why are upright C-spines preferred?
- demonstrate alignment and ligament stability
- natural curvature of the spine
- shoulders depressed
How to reduce dose on C-spine obliques?
PA obliques, less dose to thyroid
What is orthostatic breathing used for?
On T-spine to blue out overlying structures
Clay shoveller’s fracture?
- hyperflexion
- avulsion fracture of the spinous process of C6-T1
- seen on lateral C-spine
Compression fracture?
- associated with osteoporosis
- collapse of a vertebral body
- increases kyphosis
- seen on lateral projection
Hangman’s fracture?
- pedicle of C2 with or without subluxation of C2 on C3
- extreme hyperextension
- seen on lateral C-spine, anterior displacement of C2
Jefferson’s fracture?
- comminuted fracture of the anterior/posterior arch of C1
- landing on head or feet
- AP odontoid, lateral c-spine
Odontoid fracture?
- dens fracture, can be extended into lateral masses/arches
- AP odontoid
- 3 classes
3 classes of odontoid fracture?
- Top of dens: rare, potentially unstable
- Base of dens: unstable
- Extends to lateral masses: best prognosis for healing
Teardrop/burst fracture?
- compression with hyperflexion
- comminuted vertebral body fracture with triangular fragments avulsed from anteroinferior vertebral body
- posterior vertebral body in spinal canal
- quadriplegia/neurological damage
Bowtie artifact?
- lateral c-spine
- vertebral body rotated on axis
- zygapophyseal joint out of alignment
Bilateral locked facets?
-both zygapophyseal joints disrupted
HNP “slipped disk”
- nucleus pulposus protrudes through the annulus fibrosis into spinal canal
- most common L4/L5
Kyphosis?
- extreme convex curvature of the spine
- caused by: compression fracture in osteoporotic patients, poor posture, rickets, other
Scoliosis?
- lateral curvature of the spine
- most common in children 10-14, girls
Osteoarthritis?
-degeneration of a joint
Osteoporosis?
-decreased bone density
Scheurermann’s disease?
- begins in adolescence
- abnormal spine curvature of kyphosis and scoliosis
- more common in boys
- symptoms disappear, but some curvature still remains
Spondylitis
Inflammation of the vertebrae
Ankylosing spondylitis?
- men ages 20-40
- inflammation of the SI, intervertebral, costovertebral joints, paraspinal calcification and ossification, fusions of joints (ankylosing)
Spondylosis?
-age related degeneration of the intervertebral disk spaces
Transitional vertebra?
- incidental finding
- vertebrae takes on the characteristics of the adjacent region of the spine
What are flexion/extension laterals for?
- demonstrate the anterior/posterior vertebral mobility
- rule out whip lash or post op
Fuchs vs Judd views?
Fuchs: AP, cephalad angle
Judd: PA, caudad angle
-to demonstrate the upper portion of the dens when not well visualized on the odontoid view
AP wagging jaw?
- to visualize C1-T2
- jaw in continuous movement during exposure
AP Axial-vertebral arch (pillars)
- C4-C7 vertebral pillars/spinous processes (with whip lash)
- 20-30 degrees caudad
- hyperextended neck
Lateral C-spine: vertebral foramina of C1 seen
Head tilted towards the IR, adjust inter pupillary line perpendicular to IR
Lateral c-spine: posterior arch of C1 is in profile, but the cranial occipital cortices and the mandibular rami are not aligned?
Head tilted away from the IR
What view demonstrated a Jefferson #?
Odontoid
What do the oblique views demonstrate?
-stenosis of the intervertebral foramen
Angling for AP c-spine?
- 15 degrees cephalad when supine
- 20 degrees cephalad when upright or when lordotic curve evident
