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Imaging II > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

Standard projections of cervical spine:

A

AP

lateral views

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2
Q

When is swimmer’s lateral projection performed?

A

necessary to assess lower cervical segments and cervicothoracic junction

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3
Q

What view should be ordered with trauma cases with suspicion of cervical spine fracture?

A

cross-table lateral, AP, and APOM views

patient immobilized

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4
Q

When are bilateral oblique projections obtained?

A

when assessment of neural foramina necessary

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5
Q

What can flexion-extension lateral views asses?

A

instability

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6
Q

Examination of pediatric patients at high risk for instability, should have what view?

A

active lateral flexion/extension view

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7
Q

CT for cervical spine is more sensitive detecting what?

A

subtle injuries and better at visualizing craniovertebral and CT junctions

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8
Q

When is MRI for cervical spine recommended?

A

recommended for any patient with neurological deficit for its ability to demonstrate position of bony fragments as well as injury to spinal cord, disk, and soft tissues

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9
Q

What are the evidence based guidelines to help determine if a patient needs radiographic examination?

A

Canadian C-Spine Rule (CCR)

National Exmergency X-Radiography Utilization Study (NEXUS)

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10
Q

Who does CCR apply to?

A

patient who are alert and medically stable

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11
Q

CCR definition

A

Tool designed to decide whether conventional radiography of c-spine necessary for patients who have sustained traumatic injury involving head o

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12
Q

What questions does the CCR ask?

A
  1. Are there any high-risk factors that mandate radiography?
  2. Are there any low-risk factors that allow safe assessment of ROM?
  3. Is patient able to rotate neck actively at least 45° to right and left?
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13
Q

What are examples of high risk factors?

A

older than 65
dangerous MOI
parenthesis in extremities

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14
Q

What are examples of low risk factors that allow for assessment of ROM?

A 
simple rear-end motor vehicle accident
normal sitting position
patient ambulatory at any time
delayed onset of neck pain
absence of mid-line cervical spine tenderness
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15
Q

What is CCR sensitivity and specificity?

A

sensitivity: 100%
specificity: 43%

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16
Q

What is NEXUS?

A

low-risk criteria developed to help identify patients following trauma who do not need diagnostic imaging for c-spine based on their clinical presentation

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17
Q

What are the guidelines for NEXUS:

A 
No posterior midline cervical tenderness
No evidence of intoxication
Normal level of alertness and consciousness
No focal neurological deficit
No painful distracting injuries
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18
Q

What is NEXUS sensitivity and specificity?

A

sensitivity: 99.6%
specificity: 12.9%

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19
Q

What are the ACR recommendations if a patient meets CCR and NEXUS criteria?

A

CT with sagittal and coronal reformatting or both CT and MRI as complementary studies to assess instability or myelopathy

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20
Q

If patient has a history of trauma, what is viewed first?

A

lateral view if not being evaluated at trauma center wit advanced imaging

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21
Q

What do lateral views allow for?

A

assessment of normal cervical alignment with series of parallel vertebral lines

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22
Q

How is the cross-table lateral view performed?

A

in severe trauma cases, performed on supine, immobilized patient
preliminary diagnostic screen

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23
Q

What does the lateral flexion/extension view stress?

A

views performed to expose excessive segmental motion during functional movement

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24
Q

What do stress view give joint?

A

more opportunity to reveal instability by imposing mechanical stress

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25
Q

What does evaluation of radiographs for significant signs of cervical trauma include:

A

soft tissues
vertebral alignment
joint characteristics

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26
Q

What are abnormal soft tissue signs?

A
  1. widened retropharyngreal or retrotracheal spaces
  2. displacement of trachea or larynx
  3. displacement of prevertebral fat pad
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27
Q

What is the prevertebral tissue distance in adults?

A

6 at 2 and 22 at 6

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28
Q

What do abnormal vertebral alignment signs include?

A
  1. loss of parallelism
  2. loss of lordosis
  3. acute kyphotic angulation with widened interspinous space
    4 rotation of vertebral body
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29
Q

What does loss of parallelism indicate?

A

fracture, dislocation, or severe degenerative changes

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30
Q

What does loss of lordosis indicate?

A

muscle spasm in response to underlying injury

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31
Q

What does acute kyphotic angulation with widened interspinous space
indicate?

A

rupture of posterior ligaments

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32
Q

What does rotation of vertebral body indicate?

A

unilateral facet dislocation, hyperextension fracture, muscle spasm, or disk or capsular injury

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33
Q

What is included in abnormal joint signs?

A
  1. widened ADI
  2. widened interspinous process space
  3. widened IVD space
  4. narrowed IVD space
  5. loss of facet joint articulation
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34
Q

What does widened ADI indicate?

A

degeneration, stretching, or rupture of transverse ligament

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35
Q

What does widened interspinous process space (fanning) indicate?

A

rupture of interspinous and other posterior ligaments

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36
Q

What does widened IVD space indicate?

A

posterior ligament rupture

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37
Q

What does narrowed IVD space indicate?

A

rupture of disk and extrusion of nuclear material

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38
Q

What does loss of facet joint articulation indicate?

A

dislocation

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39
Q

What are stable injuries?

A

protected from significant bone or joint displacement by intact posterior spinal ligaments

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40
Q

What is an example of a stable injury?

A

compression fractures, traumatic disk herniations, and unilateral facet dislocations

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41
Q

What is an unstable injury?

A

show significant displacement initially or have potential to become displaced with movement

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42
Q

What are examples of unstable injury?

A

fracture–dislocations and bilateral facet dislocations

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43
Q

What are the most frequently injured levels?

A

C1-C2

C6-C7

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44
Q

What do adults usually injure?

A

lower c-spine

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45
Q

What are children more likely to injure?

A

upper c-spine

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46
Q

What portion of all spine cord injuries occur in c-spine?

A

2/3

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47
Q

What is SCIWORA?

A

spinal cord injury without radiographic abnormalities syndrome

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48
Q

Who is SCIWORA predominant in?

A

children with inherent elasticity in pediatric spine

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49
Q

What does SCIWORA cause in children?

A

ligamentous injury and cartilaginous vertebral endplate fractures

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50
Q

What can result in central cord syndrome?

A

adults, acute disk prolapse and/or excessive buckling of ligamentum flavum into canal already compromised by posterior vertebral body

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51
Q

Mechanisms of injuries of fractures are classified how?

A

direct

indirect

52
Q

What are the two fracture configurations seen in c-spine?

A

avulsion fractures

compression/impaction fractures

53
Q

How do avulsion fractures occur?

A

as bone fragment pulled off by violent muscle contraction or by passive resistance of ligament applied against an oppositely directed force

54
Q

What is the result when adjacent vertebrae are forced together?

A

compression or impaction fracture

55
Q

What does an axial compression force produce?

A

comminuted or burst fracture of impacted vertebral body

56
Q

What do flexion forces produce?

A

compresses impacted vertebral body into an anterior wedge shape

57
Q

What do extension forces do?

A

fractures and compresses articular pillar

58
Q

What are some commonly seen fractures of C3-C7?

A 
wedge
burst
teardrop
articular pillar
clay shoveler's
transverse process fracture
59
Q

What is a wedge fracture?

A

occurs when an interposed vertebra is compressed anteriorly by two adjacent vertebrae owing to hyperflexion forces

60
Q

Where do a majority of wedge fractures happen?

A

2/3 in c-spine at C5,C6 or C7

61
Q

Why can wedge fractures be stable?

A

because ligamentous structures are at least partially intact

62
Q

What a burst fracture?

A

occurs when IVD axially compressed and NP driven through an adjacent vertebral endplate, causing literal bursting apart of vertebral body and resulting in comminution

63
Q

Is a burst fracture stable or unstable?

A

either, depending on fracture configuration

64
Q

What is a teardrop fracture?

A

occurs when triangular fragment of bone becomes separated from anteroinferior corner of vertebral body

65
Q

What causes a teardrop fracture?

A

either avulsion force sustained during hyperextension or compressive force sustained during hyperflexion

66
Q

What is the most severe of lower cervical fractures?

A

flexion teardrop fracture

67
Q

What can posterior displacement of vertebral body cause?

A

anterior cord compression resulting in quadaplegia

68
Q

What is an articular pillar fracture?

A

fractured by a compressive hyperextension force combined with a degree of lateral flexion

69
Q

Where does a articular pillar fracture most frequently occur?

A

C6

70
Q

Is an articular pillar fracture stable or unstable?

A

stable

71
Q

What is a clay shoverler’s fracture?

A

avulsion fracture of SP produced by hyperflexion forces or forceful muscular contraction of trapezius/rhomboids

72
Q

What is often associated with a clay shoveler’s fracture?

A

repetitive heavy labor of upper extremities

73
Q

Where does a clay shoveler’s fracture more frequently occur?

A

at C6, C7 and T1

74
Q

Is a clay shoveler’s fracture stable or unstable?

A

stable

75
Q

What is a transverse process fracture?

A

uncommon, but usually occurs at largest TVP in c-spine (C7)

76
Q

What does a transverse process fracture result from?

A

lateral flexion forces causing an avulsion at tip of contralateral TVP

77
Q

If instability suspected without neurological complaint, what view is taken?

A

flexion and extension stress views

78
Q

What is conservative treatment for stable fractures?

A

rigid orthosis

79
Q

How are dislocations desribed?

A

by directions that superior vertebra segment moved

80
Q

What are the most serious and life-threatening injuries to c-spine?

A

fracture-dislocations

81
Q

What is Hangman’s fracture usually associated with?

A

anterior dislocation of C2 on C3

82
Q

What causes a fracture-dislocation of atlantoaxial joint?

A

fracture through base of dens combined with ligament rupture

83
Q

What may cause vertebral body to displace anteriorly transecting or contusing spinal cord?

A

fractures of posterior vertebral structures combined with tears of posterior ligaments

84
Q

Dislocations not associated with fractures maybe either”

A

complete or self reducing

85
Q

What are self reducing dislocations?

A

force momentarily disengages articulations, which then return to normal alignment once force dissipates

86
Q

Complete facet dislocation may occur:

A

unilaterally

bilaterally

87
Q

What does unilateral facet joint dislocation result from?

A

flexion- rotation force

88
Q

What does bilateral facet joint dislocation result from?

A

hyperflexion force

89
Q

What are locked facets?

A

when inferior articulating process of uppermost vertebra will lie in front of superior articulating process of subjacent vertebra-locking out normal articulation

90
Q

What does unilateral facet dislocations tear?

A

one facet capsule and posterior ligaments

91
Q

When is unilateral facet dislocation a stable injury?

A

absence of vertebral body subluxation

92
Q

Why are bilateral facet dislocations unstable?

A

because extensive disruption of posterior ligaments, facet joint capsules, annulus fibrosus and sometimes anterior longitudinal ligament

93
Q

When does atlantoaxial rotary subluxation occur?

A

when forces of flexion or extension combine with rotation to cause one inferior facet of C1 to slip anterior to superior facet of C2 and become fixed in this position

94
Q

What does reduction involve?

A

traction techniques supplemented by active ROM exercises to restore alignment

95
Q

Cervical sprains are injuried to what?

A

ligaments of spine

96
Q

What do hyperflexion sprains disrupt?

A

posterior ligament complex

97
Q

What do tears of posterior ligaments allow?

A

superior vertebra of segment to rotate or translate anteriorly on it subjacent vertebra

98
Q

When do hyperextension sprains result?

A

when neck forced past end ranges of extension

99
Q

What do hyperextension sprains disrupt?

A

anterior ligaments and soft tissues, resulting in transient posterior subluxation of vertebral segment

100
Q

What leads to degenerative disk disease (DDD)?

A

degeneration of IVDs

101
Q

What leads to degenerative joint disease (DJD)?

A

osteoarthritic changes at synovial facet joint

102
Q

What is foraminal encroachment?

A

diminished normal dimensions of IVF secondary to degenerative changes in adjacent structures

103
Q

What is spondylosis?

A

osteophyte formation at joint margins

104
Q

What is spondylosis deformans?

A

advance spur formation from degeneration of vertebral bodies

105
Q

What is diffuse idiopathic skeletal hyperostosis (DISH)?

A

flowing ossification along anterior vertebral bodies and disk space

106
Q

What is included in degnerative changes in disk?

A

dehydration, nuclear herniation, annular protrusion, and fibrous replacement of annulus

107
Q

What does DDD present with?

A

Schmorl’s nodes and vacuum phenomenon

108
Q

What is the radiographic hallmark of DDD?

A

decreased height of disk space

109
Q

How are Schmorl’s nodes identified?

A

radiolucent focal defects in vertebral endplates

110
Q

How does vacuum phenomenon present?

A

horizontally oriented radiolucency within disk space

111
Q

Why are facet joint vulnerable to DJD?

A

great mobility of c-spine, postural strains, and repetitive occupational or recreational actions that contribute to abnormal tissue and joint biomechanics

112
Q

What are the hallmark images of DJD?

A

decrease in joint space, subchondral sclerosis, and osteophytosis

113
Q

What is foraminal encroachment a result of?

A

result of degenerative changes in adjacent structures (including DDD and DJD) that diminish size of IVF

114
Q

How is encroachment seen on film?

A

narrowing of radiolucent ovals that represent

115
Q

What is cervical spine spondylosis in response to?

A

formation of osteophytes in response to DDD

116
Q

Where is osteophyte formation most prominent in cervical spine spondylosis?

A

points in curvatures of spine farthest from center of gravity line, or at apices of concavities, as result of greater segmental mobility

117
Q

What are the c-spine site of osteophyte formation in cervical spine sponydlosis?

A

C4-C5

C5-C6

118
Q

What is spondylosis deformans?

A

degenerative condition characterized by anterior and lateral vertebral endplate osteophytosis that results from anterior or anterolateral disk herniation

119
Q

What images demonstrate osteophytes in spondylosis deformans?

A

AP or lateral

120
Q

What is DISH associate with?

A

diabetes, growth hormone, vitamin A or retinoid derivatives, and metabolic syndromes

121
Q

What age and sex is DISH associated?

A

age 40, more frequently with men

122
Q

What is the most common site for DISH?

A

middle to lower thoracic spine and upper lumbar spine, as well as lower cervical spine

123
Q

What are clinical symptoms of DISH?

A

mild pain and stiffness

124
Q

How is DISH assessed?

A

Assessed on lateral view, three radiographic criteria define DISH

125
Q

How is DISH distinguished from spondylosis deformans?

A
  1. Flowing ossification along anterolateral aspects of at least four contiguous vertebral bodies
  2. Relative preservation of disk height and absence of radiographic evidence of DDD
  3. Absence of facet joint DJD or sacroiliitis

Imaging II (10 decks)

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