Cervical Spine

Question 1

Why are cervical spine precautions so important

Answer 1

Patients are at a high risk of paralysis, shock, and death

Question 2

Who can perform manipulation of a patient’s head when they are in c-spine precautions

Answer 2

The attending physician

Question 3

What are the four projections usually taken in a trauma c-spine

Answer 3

1)AP Axial
2)Odontoid
3)X-Table Lateral
4)Swimmers

Question 4

What projection is usually done first

Answer 4

X-Table Lateral

Question 5

When is a swimmers necessary

Answer 5

When the articulation between C7 and T1 is not clearly seen

Question 6

When a patient arrives in a C spine collar can we assume the paramedics have removed artifacts

Answer 6

No, we still need to look for artifacts

Question 7

What are some commonly missed artifacts when performing C-spine

Answer 7

Necklaces, earrings, BOBBY PINS, dental retainers

Question 8

What is the CR for X-table lateral for cervical spine

Answer 8

Perpendicular to IR, at level of C4

Question 9

What is a method of locating C4 on a patient

Answer 9

Halfway between EAM and Jugular notch

Question 10

What should you bear in mind when finding the mid coronal plane of a patient in a c-spine collar

Answer 10

The collar adds a lot of space posteriorly and especially anteriorly. Follow the EAM to find the midline

Question 11

What is the preferred SID for X-table lateral of the cervical spine

Answer 11

180cm

Question 12

Do we need a grid for X-table lateral of C-spine in a collar

Answer 12

No, the air ga technique compensates for lack of grid

Question 13

What anatomy needs to be included on a X-table lateral C-spine

Answer 13

Sella turcica to T1(in its entirety). Soft tisue and retropharyngeal tissue as well.

Question 14

What is anatomy we DO NOT want to include on X-table lateral C-spine

Answer 14

Orbits, Nose, Skull, Shoulder below C7/T1

Question 15

What are the three “lines” that radiologists will use to evaluate C-spine

Answer 15

1) Anterior contour line
2)Posterior contour line
3)Spinolaminar contour line

Question 16

What is a Hangman’s Fracture

Answer 16

A hyperextension injury that fractures the anterior arch of C2. Often this also causes subluxation of C2 and C3

Question 17

What commonly causes Hangman’s Fractures (especially in trauma)

Answer 17

Whiplash. Also from, as the name implies, Hanging injuries

Question 18

What is a compression fracture of C-spine

Answer 18

A Hyperflexion injury resulting in an anterior compression of a vertebral body. This causes compaction of the bone.

Question 19

What is a teardrop extension fracture

Answer 19

Hyperextension causing a traingular fragment of the vertebra to be avulsed off the body and leave a “teardrop” fragment

Question 20

What is the most common site for a teardrop fracture

Answer 20

C2

Question 21

What is the most common site of a spinous process fracture

Answer 21

C6 or C7

Question 22

What is the cause of a spinous process fracture

Answer 22

flexion as the body or neck rotates

Question 23

What is the CR for a swimmers

Answer 23

Perpendicular to IR at C7/T1

Question 24

What are some indicators that an Odontoid is positioned correctly

Answer 24

Base of the skull is aligned with upper teeth, Symmetrical periodontoid space, Entirety of the C2 lateral masses can be seen, We cn see the transverse processes of C1

Question 25

If a patient cannot line up their EAM with the occlusal plane what do we do

Answer 25

Angle the tube

Question 26

What is the Mach Effect

Answer 26

When artifacts or the upper incisors/occipital bone/soft tissue overlay the peg and mimics a fracture

Question 27

What is a Burst/Jefferson Fracture

Answer 27

A Communited fracture of C1 caused by axial compression

Question 28

What will you visually see on an odontoid image that may indicate a burst fracture

Answer 28

Unilateral widening of the peg joint space on C1 or C2

Question 29

What is the Fuchs method

Answer 29

A method to obtain an odontoid image without the patient opening their mouth. Angle the CR cephalad through the Mentum and Mastoid processes towards C1/C2