Cervical Review & Eval

Question 1

general indications for C-spine imaging

Answer 1

traum
suspected instability
UE symptoms
occipital HA
ROM limitations
pre-op/post-op
malignancies
arthropathy
suspected congenital abnormality
health conditions associated w/ spinal abnormality
monitoring known abnormality

Question 2

best view to see cervical intervertebral foramin

Answer 2

oblique 45 deg

Question 3

best view to see cervical z-joints

Answer 3

lateral view

Question 4

what can you see in a AP lower C-spine view

Answer 4

SPs
lateral bodies
lateral columns
ovular pedicles

Question 5

smooth lines for c-spine

Answer 5

anterior & posterior bodies
spinolaminar line
articular pillars

Question 6

what can you see in a right & left oblique view

Answer 6

IV foramina
pedicles

Question 7

flexion-ext stress view

Answer 7

lines
spatial relation to the bodies
excessive widening of atlantodental interface in flexion

Question 8

ABCDs for c-spine CT & MRI

Answer 8

alignment
bone signal
canal space
disc integrity
soft tissues

Question 9

general indications for CT

Answer 9

acute trauma
degenerative conditions
post-op assessment
infxn
image-guided intervention procedures
neoplasm
inflammatory lesions
congenital/developmental conditons
cord syrinxes/masses (MRI contraindicated)

Question 10

general indications for MRI

Answer 10

acute trauma w/ suspected cord encroachment
DDD
neoplasm
intrinsic spinal cord path
congenital/developmental conditions
cord masses
post-op assessment
meningeal abnormalities
infxn

Question 11

C-spine
new or increasing nontraumatic cervical or neck pain
no red flags
initial imaging -

Answer 11

x-ray

Question 12

C-spine
new or increasing nontraumatic cervical radiculopathy
no red flags
initial imaging -

Answer 12

MRI

Question 13

C-spine
chronic cervical or neck pain
initial imaging -

Answer 13

x-ray

Question 14

myelopathy
acute
initial imaging -

Answer 14

MRI

Question 15

myelopathy
chronic / progressive
initial imaging -

Answer 15

MRI

Question 16

suspected spine trauma
age > or equal to 16 and <65
suspected acute blunt cervical spine trauma
imaging not indicated by NEXUS or CCR
pt meets low risk criteria
initial imaging -

Answer 16

none

Question 17

suspected spine trauma
age > or equal to 16
suspected acute blunt cervical spine trauma
imaging indicated by NEXUS or CCR
initial imaging -

Answer 17

CT

Question 18

suspected spine trauma
age > or equal to 16
suspected acute blunt cervical spine trauma
confirmed / suspected cervical spinal cord or nerve root injury w/ or w/o traumatic injury identified on cervical CT
next imaging -

Answer 18

MRI

Question 19

suspected spine trauma
age > or equal to 16
suspected acute blunt cervical spine trauma
clinical or imaging suggest ligamentous injury
next imaging study after CT cervical spine w/o IV contrast

Answer 19

MRI

Question 20

C-spine, suspected spine trauma - child

3 to 16
acute cervical spine trauma
meets low risk criteria
initial imaging -

Answer 20

none

Question 21

PECARN - when do you do imaging

Answer 21

one or more are the risk factors present

Question 22

PECARN risk factors

Answer 22

AMS
focal neurologic findings
neck pain
torticollis
substantial torso injury
conditions predisposing to cervical spine injury
diving
high-risk motor vehicle crash

Question 23

C-spine

child, 3-16
acute cervical spine trauma
at least one risk factor w/ reliable clinical examination based on PECARN and NEXUS
initial imaging -

Answer 23

x-ray