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622: Human Imaging I > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

How many vertebrae are in the vertebral column?

A

33

7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused) and 4 coccygeal (fused)

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2
Q

What 3 anatomical regions is the cervical spine best analyzed on plain films?

A
  • First cervical segment (C1)
  • Second cervical segment (C2)
  • Remainder of distal cervical segments
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3
Q

2 reasons why C1 is unique to other cervical vertebrae

A
  • it has no vertebral body, which means it has no annulus for stabilization
  • It is wrapped around a cephalad projection of vertebral body of C2 known as “odontoid” or “dens”
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4
Q

Which ligament holds the dens in proper alignment

A

Transverse ligament

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5
Q

The transverse ligament prevents ______ displacement of C1 on C2

A

anterior

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6
Q

The articular facets at C1 are more horizontally oriented in AP plane to facilitate which movement?

A

rotation

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7
Q

Transverse ligament incompetence can be due to what 3 things?

A

1) Congenital laxity
2) Rupture of the ligament by trauma
3) Progressive diseases such as RA

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8
Q

Does C1 have an intervertebral disc?

A

NO

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9
Q

Because C1 does not have an IVD what two things are decreased?

A

Shock absorption and stabilization

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10
Q

The articular facets of C1 are _____ in the AP plane, but they are wedge shaped in the ML plane with the ___ dimension smaller than the ____ dimension

A

horizontal
medial
lateral

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11
Q

The _____ is the “pillar” around which ring of C1 rotates and to which C1 anchored by transverse ligament

A

odontoid/dens

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12
Q

Odontoid/dens fractures may be caused by what 3 things?

A
  • Trauma
  • Developmental congenital malformation
  • Failure to fuse
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13
Q

Odontoid fractures are categorized as types I, II, and III based on what?

A

Location and direction of fracture

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14
Q

Describe a Type I odontoid fracture

A

oblique fracture through upper ⅓ of the odontoid

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15
Q

Describe a Type II odontoid fracture

A

transverse fracture through the base of the odontoid where it joins and is joins with the body of C2

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16
Q

Describe a Type III odontoid fracture

A

fracture of odontoid down into body of C2 (most serious)

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17
Q

In what view can you see a dens fracture?

A

AP Open Mouth (APOM)

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18
Q

What are the 5 standard views required to perform basic evaluation of the cervical spine with plain film x-rays?

A

1) Odontoid (open-mouth) view (APOM)
2) AP
3) Left oblique
4) Right oblique
5) Lateral

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19
Q

Which views are only taken when absolutely necessary?

A

The oblique views

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20
Q

What is APOM used to see?

A

CI and C2

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21
Q

What is a Jefferson’s fracture?

A

a bone fracture of the anterior and posterior arches of the C1 vertebra

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22
Q

How is a Jefferson’s fracture diagnosed?

A

APOM view and it is demonstrated by lateral overhanging of lateral mass beyond the lateral margins of C2 superior articular processes

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23
Q

Greater than _ mm of bilateral offset of the lateral masses of C1 relative to C2 is considered abnormal.

A

2

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24
Q

In the APOM view, if there is overhang of the lateral masses of C1 relative to C2, but it is less than 2 mm what can it be attributed to?

A

head rotation/tilt

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25
Q

In the APOM view the articular surfaces of the facets should be ____ to one another and equally spaced.

A

parallel

26
Q

An AP view of the cervical spine allows you to view what?

A

The anteroposterior portion of the cervical spine from C3 to C7

27
Q

How can you determine any segmental rotation between the lower cervical spine in an AP view?

A

A vertical line can be drawn along the spinous processes from superior to inferior

28
Q

What 3 other things (other than spinous process alignment) can you check in the AP view?

A
  • Identify the pedicles at each segment and assessed for indications of segmental rotation
  • Vertically assess the lateral borders of the vertebral bodies to assess any segmental lateral displacement or unilateral segmental “tilting”
  • Evaluate uncinate joints (two at each superior and inferior portion of vertebral bodies) and look for any osteophytes or degenerative changes
29
Q

How do you asses bone density and dimension of the lower C-spine?

A

Segments above and below can be used for comparison and if necessary you can measure horizontal and vertical dimensions in millimeters for comparison

30
Q

In the AP view which soft tissue structure can be seen very clearly?

A

the air-filled trachea

31
Q

What 3 things may be present if the trachea is not midline?

A
  • Tumor (Pancoast’s-lung tumor)
  • Pneumothorax
  • Hemothorax
32
Q

How many oblique views should be taken of the cervical spine?

A

Two (a right and left side) to compare side-to-side consistency

33
Q

Oblique views are used to evaluate what two things?

A

1) The status of intervertebral foramina (primarily)

2) Also provides excellent views of pedicles and articular facets

34
Q

When examining the IVF in the oblique view, what things are you looking for?

A

Evaluate the dimensions of the foramina above and below for good measures of appropriate patency of each opening. From this you can determine if there is any existence of osteophytes or stenotic changes

35
Q

Which view of cervical spine is usually the most informative?

A

Lateral view

36
Q

Assessment of lower cervical spine cartilage is best evaluated with what view?

A

Lateral cervical view

37
Q

In the lateral view anterior and posterior bodies should align themselves in a smooth ____ curve.

A

lordotic

38
Q

If the usual lordotic curve is missing what does this suggest?

A

spasm of cervical muscles

39
Q

What is the first landmark on the lateral view that requires specific evaluation?

A

The atlantodens interval (ADI)

40
Q

The atlantodens interval (ADI) most not exceed _ mm

A

3 mm

41
Q

If the ADI is greater than 3 mm what does this suggest?

A

There is instability between C1 and C2 (ominous)

42
Q

What are the 3 risk factors for ADI compromise?

A

1) Significant cervical trauma
2) Connective tissue/autoimmune disease, such as RA, juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus
3) Congenital disease, such as Down syndrome

43
Q

Does the ADI widen with cervical flexion?

A

NO, unless there is trauma or a pathological condition that would allow C1 to sublux anteriorly with cervical flexion

44
Q

Alignment is evaluated in the lateral view by drawing lines superior to inferior along what 3 structures?

A

1) Anterior longitudinal ligament (ALL)
2) Posterior longitudinal ligament (PLL)
3) Along the line created by junctions of lamina and spinous processes

45
Q

If the portion of one segment appears slightly anterior to the ALL and PLL and yet the laminar-spinous process line appears posterior to the segments above and below what type of fracture might this indicate?

A

Hangman’s fracture

46
Q

How do hangman’s fractures typically occur?

A

rapid deceleration (hanging) or with hyperextension (MVA – chin to dashboard)

47
Q

Can a hangman’s fracture occur without displacement of the vertebral body?

A

Yes, there may be a fracture though the pedicles, but no displacement

48
Q

What is Ankylosing Spondylitis?

A

It is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture

49
Q

An x-ray of ankylosing spondylitis (bamboo spine) has what to distinct characteristics?

A
  • Vertical whitening represented by trolley track signs

- Dagger signs where the interspinous ligaments and supraspinous ligaments are calcifying

50
Q

How can you determine if a patient has RA by viewing their x-ray?

A

There is decreased mineralization of cervical spine which may result in anterior subluxation

51
Q

How can you determine if someone has a compression fracture?

A

The height of one of their vertebral bodies is less than the other vertebrae

52
Q

Pathological IVD conditions are divided into diseases of what two structures?

A

1) annulus fibrosis

2) Nucleus Pulposus

53
Q

Describe the vacuum phenomenon

A

When an HNP occurs, over time, nitrogen moves from cartilaginous endplates of vertebral bodies into potential space created by evacuation of NP and becomes visible as an area of ↓ density within confines of intervertebral space

54
Q

Areas of decreased density in the prevertebral tissue region may be indicative of what?

A

hemorrhage from an occult fracture of vertebrae that is immediately posterior to lucency

55
Q

An increased distance between spinous processes may indicate what?

A

tear of interspinal ligament and supraspinal ligament, indicating potentially severe segmental instability

56
Q

In addition to cervical spasm, what can cause a loss of lordosis?

A

a decreased disk space at C3-4 and possible incomplete segmentation at this level in columns two and three of C3 to C4

57
Q

Dislocation of C5 is also known as what?

A

A bow-tie deformity

58
Q

Dislocation of C5 is represented by ____ displacement of the vertebral body

A

anterior

59
Q

An absence of space between 2 vertebral bodies may represent what?

A

herniation of NP or failure of embryonic segmentation at one or multiple levels

60
Q

Spina bifida occulta of atlas indicated by what 2 things?

A

1) absence of spinal laminal line in lateral projection

2) incompletely ossified posterior arch in APOM projection

61
Q

Block segments are secondary to either ____ or ____

A

surgery (pathology) or congenital

62
Q

How can you tell the difference between congenital and surgical block segments?

A

Congenital block segment often has “wasp waist” transverse narrowing
Surgical or pathologic block segments tend to appear more columnar

622: Human Imaging I (7 decks)

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