Cervical Review & Eval Flashcards
general indications for C-spine imaging
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
best view to see cervical intervertebral foramin
oblique 45 deg
best view to see cervical z-joints
lateral view
what can you see in a AP lower C-spine view
SPs
lateral bodies
lateral columns
ovular pedicles
smooth lines for c-spine
anterior & posterior bodies
spinolaminar line
articular pillars
what can you see in a right & left oblique view
IV foramina
pedicles
flexion-ext stress view
lines
spatial relation to the bodies
excessive widening of atlantodental interface in flexion
ABCDs for c-spine CT & MRI
alignment
bone signal
canal space
disc integrity
soft tissues
general indications for CT
acute trauma
degenerative conditions
post-op assessment
infxn
image-guided intervention procedures
neoplasm
inflammatory lesions
congenital/developmental conditons
cord syrinxes/masses (MRI contraindicated)
general indications for MRI
acute trauma w/ suspected cord encroachment
DDD
neoplasm
intrinsic spinal cord path
congenital/developmental conditions
cord masses
post-op assessment
meningeal abnormalities
infxn
C-spine
new or increasing nontraumatic cervical or neck pain
no red flags
initial imaging -
x-ray
C-spine
new or increasing nontraumatic cervical radiculopathy
no red flags
initial imaging -
MRI
C-spine
chronic cervical or neck pain
initial imaging -
x-ray
myelopathy
acute
initial imaging -
MRI
myelopathy
chronic / progressive
initial imaging -
MRI
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 -
none
suspected spine trauma
age > or equal to 16
suspected acute blunt cervical spine trauma
imaging indicated by NEXUS or CCR
initial imaging -
CT
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 -
MRI
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
MRI
C-spine, suspected spine trauma - child
3 to 16
acute cervical spine trauma
meets low risk criteria
initial imaging -
none
PECARN - when do you do imaging
one or more are the risk factors present
PECARN risk factors
AMS
focal neurologic findings
neck pain
torticollis
substantial torso injury
conditions predisposing to cervical spine injury
diving
high-risk motor vehicle crash
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 -
x-ray
