Cervical Spine Flashcards
Osteoarthritis is more common to develop at what levels
C5/C6
What findings are seen here
Degenerative disc C5/C6
Loss of disc height with no vacuum cleft is key for this radiographic diagnosis =
Degenerative disc
Maintained disc height with osteophytes is the key for this radiographic diagnosis =
Spondylosis
Loss of disc height with a vacuum cleft is key for this radiographic diagnosis =
Intervertebral Osteochondrosis (IVOC)
What arthritic condition is the result of these findings
With intercalary bone circled
What arthritic condition is the result of these findings?
Blunting/hypertrophy of uncinates that gives pseudofracture appearence to vertebral body on lateral view =
Uncinate arthrosis
What condition is demonstrated in these findings?
Left = normal
Facet arthrosis
(middle = moderate, right = severe)
What condition is demonstrated by these findings?
Spondylotic myelopathy
General features of ____ include:
- Ossification/calcification of spinal/extraspinal ligaments & tendinous attachments (most prominent = ALL)
- Flowing hyperostosis at four continuous vertebral levels
- Relative preservation of disc height
- Absence of SI and facet joint sclerosis, osseous fusion
- May see associated ossification of the posterior longitudinal ligament (OPLL) (can cause myelopathy)
- Dysphagia is common sx
DISH (Diffuse Idiopathic Skeletal Hyperostosis)
What condition is likely the cause of these findings?
Radiographic features of ____ include:
- ADI instability (due to inflammatory changes at articulation of transverse ligament w/ the dens)
- Odontoid eroisions (resulting in a whittled dens) & sclerosis
- Facet erosions & sclerosis
- Whittling of SPs
- Anterolisthesis C2-C4 giving a step ladder appearence
Rheumatoid Arthritis
What condition is likely the cause of these findings?
RA w/ atlantoaxial instability
What condition is likely the cause of these findings?
RA with atlantoaxial instability
What condition is likely the cause of these findings?
RA
The primary, preferred imaging for suspected CS trauma is ___
CT (though not readily available so x-rays often first modality performed)
High risk criteria for cervical spine injury that requires imaging
65 or older
Dangerous mechanism of injury
Presence of paresthesia in extremities
____ is suggested on a neutral lateral cervical view when:
- 3.5 mm horizontal translation or 20% of the endplate distance of one vertebral segment over another
OR
11 degrees or more of angular deformity between two adjacent vertebral segments (compared to the surrounding segments)
Instability
_____ is suggested on flexion/extension radiographs when:
- Relative translation is greater than 3.5mm or 20% of the endplate distance
OR
- Over 20 degrees of sagittal plane rotation
Instability
What pathology is demonstrated here?
Cervical instability
What four lines should be checked on the lateral cervical view in the case of trauma?
Anterior vertebral body line
Posterior vertebral body line
Spinolaminar line
Spinous process line
____ general features include:
- Burst fracture from axial compression
- Usually from auto or diving accident
- 4 fx (2 ant, 2 post) is classic pattern
- Lateral displacement of C1 lateral masses
Jefferson Fracture
General & radiographic features of ____ include:
- MC from C4-C7
- Body above displaces anterior usually less than 25% of the width of the vertebral body below
- Look for bow-tie sign
- Due to hyperflexion w/ rotation
- Usually stable
Unilateral facet dislocation
What pathology is demonstrated in these 2 different cases?
General features of ____ include:
- Most common from C4-C7
- Body above displaced anterior 50% or more of the width of the vertebral body below
- Due to hyperflexion
- Unstable injury
Bilateral Facet Dislocation (C4/C5)
General & radiographic features of ____ include:
- Often referred to as Clay-shoveler fracture
- C7 MC level affected
- Due to avulsion injury or direct blow
- Stable injury
- SP moves inferior typically → results in double spinous sign on AP radiograph
Spinous process fracture
What traumatic pathology is demonstrated here?
C7 SP fracture
General & radiographic features of ____ include:
- MOI is hyperflexion with compression
- Often a result of motor vehicle accidents or diving injuries
- Unstable injury
- Anterior inferior vertebral body fracture
Flexion teardrop fracture
What traumatic pathology is demonstrated here?
C6 flexion teardrop fx
What traumatic pathology is demonstrated here?
C2 teardrop fx
General & radiographic features of ____ include:
- MC due to hyperextension
- MC in elderly
- Commonly have associated C1 fx
- 3 Types
Odontoid fracture
Type ___ Odontoid Fx =
- An oblique fx limited to superior one half of the dense, avulsion type fx
- Stable
Type I
Type ___ Odontoid Fx =
- Transverse fx at the base of the dense
- Unstable
- MC type
Type II
Type ___ Odontoid Fx =
- An oblique fx at the base of the dens and extending into the body
- Stable
Type III
What traumatic pathology is demonstrated here?
Type I dens fx
What traumatic pathology is demonstrated on this coronal MRI?
Type III dens fx
General features of ____ include:
- Etiology includes ununited type II dens fx or ununited growth center
- Can be associated w/ significant upper cervical instability
Os Odontoideum
Radiographic features of ____ include:
- Avascular disc protects joint initially in adults
- Latent period for osseous changes is 21 days
- Occurs at anterior aspect of body, spreads along endplate → endplate irregularity/destruction, body destruction, disc height loss
Infectious spondylitis
What pathology is demonstrated here?
Infectious spondylitis C5/C6
What pathology is demonstrated here?
Infectious spondylitis
Radiographic features of ____ include:
- Located in posterior elements
- Lucent, soap bubbly appearence, highly expansile
- DDx w/ aneurysmal bone cyst
Osteoblastoma
What pathology is demonstrated here?
Osteoblastoma at C1 posterior arch
Best evaluated w/ US, magnetic resonance angiography, or CT
= what pathology
Atherosclerosis of carotid arteries
General features of ____ include:
- MC at C5/C6 and C2/C3
4 radiographic findings:
- Rudimentary disc (with calcification occasionally)
- “Wasp-waist” deformity: anterior concavity at the mid-point due to failure of formation of rim apophyses
- Posterior element involvement
- Height is less than 2 normal discs
Congenital blocked vertebra
What pathology is demonstrated here?
Congenital block C5/C6
What pathology is demonstrated here?
Congenital block C5/C6
General & radiographic features of ____ include:
- Multiple block vertebra
- Other segmentation anomalies
- Associated skeletal findings (Sprengel’s deformity, rib anomalies, spina bifida, scoliosis)
- Clinical triad: short webbed neck, low posterior hairline, decreased CS ROM
Klippel Feil Syndrome
What normal anatomic variant is seen here?
Ossification of stylohyoid ligaments
What condition is associated with these findings?
Acromegaly
What condition is associated with findings seen here?
Post-menopausal/senile osteoporosis
What condition is shown here?
Klippel-Feil Syndrome
What normal anatomic variant is seen here?
Findings & Impressions =
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38 YOM ambulates into your office with a chief complaint of neck pain following a motor vehicle accident in which he rear ended another car at 10mph. What is the next step with this patient?
No high risk factors. Patient may be full evaluated with a physical exam including active ROM
67 YOM ambulates into your office with a chief complaint of neck pain following a motor vehicle accident in which he rear ended another car at 10mph. What is the next step with this patient?
Because of age, is at high risk. Patient should be evaluated with a 3 view cervical radiographic study before any active range of motion is performed
20 YOM ambulates into your office with a chief complaint of neck pain following an injury in which a box of books fell on the top of his head. What is the next step with this patient?
Because of axial load to spine, is at high risk. Patient should be evaluated with a 3 view cervical radiographic study before any active range of motion is performed.
20 YOF ambulates into your office with a chief complaint of neck pain for past 2 years. 2 years ago she recalls straining her neck while swimming (not related to a diving injury). Remaining history including review of systems is unremarkable. What is the next step with this patient?
No high risk factors. Patient may be full evaluated with a physical exam including active ROM
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Findings & Impressions =
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What normal anatomical variant is demonstrated here?
What normal anatomical variant will result in abnormal Chmberlain’s or McGregor’s line due to dens moving into foramen magnum
Basilar impression (aka basilar invagination)
This case demonstrates an normal ____ line
Chamberlain’s line
This abnormal finding is indicative of ____
Basilar impression
This abnormal finding is indicative of ____
Basilar impression
What normal anatomical variant is seen here?
