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Diagnostic Imaging > Cervical spine > Flashcards

Cervical spine Flashcards

1
Q

Standing Lateral view:

  • Pt position
  • Central beam
A
  • pt position - standing lateral view places the pt with the head in neutral
  • central beam - directed horizontally to the center of C4 vertebra
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2
Q

Lying Lateral View

  • pt position
  • central beam
A
  • pt position - supine with head in neutral position
  • central beam - horizontally to a point approx 2.5-3 cm caudal to mastoid tip
  • important the film demonstrates C7 vertebrae
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3
Q

What do you see on lateral views?

A
  • vertebral bodies
  • apophyseal joints
  • spinous processes
  • intervertebral disc
  • suffices for most traumatic injuries and is most important view
  • A/P arches of C1
  • The odontoid process in the atlanto-dens interval
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4
Q

What is the atlanto-dens interval? What should the Atlanto-dens interval not exceed?

A

space between odontoid and anterior arch of atlas

  • should not exceed 3 mm in adults whether flexed or extended
  • in children under age 8, distance has been as much as 4 cm with flexion
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5
Q

What are the 5 contour lines of the normal cervical spine?

A
  1. Anterior vertebral line
  2. posterior vertebral line
  3. spinolaminar line
  4. posterior spinous line
  5. clivus-odontoid line
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6
Q

What should the retropharyngeal space be? what should the retrotracheal space be?

A

retropharyngeal(RF) = <7mm
- important for atlanto-atlaxial translation

retrotracheal = <22mm adults, <14mm kids

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7
Q

Line drawn from posterior margin of the foramen magnum to the dorsal margin of the hard plate

A

Chamberlain line

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8
Q

What should the odontoid process projection remain to be considered normal with regards to the chamberlain line? what does it indicate if it is abnormal

A

< 3mm = normal
3-6 mm = abnormal
> 6mm = strongly suggests cranial settling

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9
Q

Line defines the opening of the foramen magnum and connects the anterior margin with posterior margin of the foramen magnum

A

McRae line

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10
Q

What should the odontoid process projection remain to be considered normal with regards to the McRae line? what does it indicate if it is abnormal

A

below line = normal

indicates atlantoaxial impaction (cranial setting)

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11
Q

AP view:

  • pt position
  • Central beam
  • structures seen
A
  • pt position - standing or supine
  • Central beam - directed toward C4 vertebra at an angle of 15-30 degrees cephalad
  • structures seen - C3-C7 vertebral bodies and the intervertebral disk spaces
  • limitation = C1-2 not adequately seen; open and close mouth rapidly = allows C1-2
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12
Q

open mouth view:

  • pt position
  • Central beam
  • structures seen
A
  • pt position - same as AP view but mouth opens as wide as possible
  • Central beam - perpendicular to the midpoint of the open mouth
  • structures seen - Best to demonstrate C1-2
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13
Q

Fuchs view:

  • pt position
  • Central beam
  • structures seen
A
  • pt position - supine on table with neck hyperextended
  • Central beam - directed vertically to the neck just below the tip of the chin
  • structures seen - odontoid process (considered if open mouth view is insufficient)
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14
Q

Oblique view:

  • pt position
  • Central beam
  • structures seen
A
  • pt position - obtained in AP or PA view; pt is rotated 45 to one side
  • Central beam - directed to C4 vertebra with 15-20 cephalad angulation
  • structures seen - intervertebral neural foramina; visualize fxs of the neural arch and abnormalities of the neural foramina and apophyseal joints
    (rotated right will demonstrate the left-sided neural foramina
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15
Q

Swimmers view:

  • pt position
  • Central beam
  • structures seen
A
  • pt position - prone with left arm abducted and the right arm on the side
  • Central beam - horizontally toward left axilla, film cassette on right side of the neck
  • structures seen - demonstration of C7-T2 visualization
    • always visualize C7** bc injuries will be missed if it is not
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16
Q

Occipital condyle fractures require high degree of suspicion by investigator. Advanced imaging (CT) will be used. They are very unstable injuries. What are the types of occipital condyle fractures?

A

Type I - impacted occipital fracture; axial loading MOI
Type II - component of basilar skull fracture; direct blow to skull
Type III - avulsion fracture of the condyle toward the tip of the odontoid; cervical rotation and lateral bending MOI; most concerning with associated instability

17
Q

Axial load transmitted symmetrically through the cranium and occipital condyles into the superior surfaces of the lateral masses of the atlas and drives the masses outwards; symmetrical fracture of the A and P arches of C1 which is associated with disruption of the transverse lies; unilateral occipital headache and neck pain are clinical characteristics

A

Jefferson fx

  • open mouth AP view best
  • may require additional CT
18
Q

MOI: hyperextension and distraction; fracture ID’d through the pedicles of C-2 and associated ligament disruption and intervertebral disk injuries

A

Hangmans fracture

- lateral view is best

19
Q

MOI: axial load that results in fractures to lower cervical spine (C3-C7); nucleus pulpus is driven through the fractured vertebral plate into the vertebral body causing a comminuted fracture

A

Burst fracture

- CT most revealing

20
Q

MOI: Compression and flexion; most severe and most unstable Cspine injury; characterized by posterior displacement into the spinal canal, fracture of posterior elements, and disruption of soft tissues

A

Teardrop fracture

  • lateral view is best, but requires MRI
  • major concern for football
  • results in acute anterior cord syndrome = loss of motor function and sensation
21
Q

MOI: caused by acute powerful flexion (shoveling) or direct blow to the cervical spine; stable fx with the posterior lig complex remaining intact; C7 should always be ID’d

A

Clay-shovelers fx

  • usually in C6 or 7
  • swimmers view if C7 can’t be visualized from lateral view
22
Q

MOI: hyperflexion of the Cspine; anterior compression of the vertebral body is misshaped into a wedge rather than block; posterior lig complex is stretched but remains in tact

A

Compression (wedge) fx

- lateral view

23
Q

What is the worst odontoid fx?

A

Transverse fracture of the odontoid

  • best viewed by AP view with open mouth
  • Fuchs and lateral as well
24
Q

What are the Canadian Cspine rules?

A
  1. High risk factors = age > 65, dangerous mechanism of injury (fall from >3ft or 5 stairs, axial load to the head, MVA high speed/ rollover/ejection, motorized rec vehicles, or bicycle struck), or numbness/ tingling in extremities
  2. if patient has low risk factors (simple rear-end MVA, sitting in ED, ambulatory, delayed onset of neck pain, or absence of midline tenderness) but unable to rotate 45 degrees

Diagnostic Imaging (5 decks)

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