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NYCC Bone & Joint > Cervical Spine Dislocation & Whiplash > Flashcards

Cervical Spine Dislocation & Whiplash Flashcards

1
Q

What are the 2 types of cervical spine dislocation?

A
  • unilateral facet dislocation
  • bilateral facet dislocation
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2
Q

What is the mechanism of a unilateral facet dislocation?

A

flexion with rotation
(pulls facet forward on opposite side)

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3
Q

What is the mechanism of a bilateral facet dislocation?

A

hyperflexion

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4
Q

What is the stability of a unilateral facet dislocation?

A

stable until reduced
(therefore treat as unstable)

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5
Q

What is the stability of a bilateral facet dislocation?

A

unstable

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6
Q

What structures are damaged with a unilateral facet dislocation?

A
  • ruptured interspinous ligaments
  • ruptured facet capsular ligaments
  • sprained PLL
  • articular process Fx common
    (requires fusion post-reduction)
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7
Q

What are the radiographic findings of a unilateral facet dislocation?

A

Lat:
- bowtie sign
- <25% anterolisthesis
AP: focal rotation

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8
Q

What sign of unilateral facet dislocation is seen only on an axial CT?

A

hamburger sign

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9
Q

What is the clinical significance of a unilateral facet dislocation?

A

neurologic deficit in 25% of pts

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10
Q

What 3 forms of facet dislocation can occur with a flexion and rotation mechanism?

A

Unilateral:
- partial dislocation
- perched facets
- complete dislocation
(lecture only)

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11
Q

What is a perched facet joint?

A

vertebral facet joint whose inf articular process appears to sit ‘perched’ on ipsi sup articular process of the vertebra below

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12
Q

What structures are damaged with a bilateral facet dislocation?

A
  • interspinous lig
  • lig flavum
  • facet capsules
  • PLL
  • 50% have disc herniation
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13
Q

What are the radiographic findings of a bilateral facet dislocation?

A
  • 50%+ anterolisthesis
  • widened interspinous space
  • NO bowtie sign
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14
Q

What is the clinical significance of a bilateral facet dislocation?

A

neurologic deficit in 75% of pts
(greater reduction in spinal canal space)

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15
Q

How would the spinal cord appear on a T2 MRI in the area of a bilateral facet dislocation?

A

cord = bright d/t hemorrhage

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16
Q

What is whiplash associated disorder?

A

cervical sprain-strain injury

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17
Q

What are the possible mechanisms for whiplash associated disorder?

A
  • 20-60% of MVAs
  • hyperextension-hyperflexion
  • acceleration-deceleration
18
Q

What is the name of the classification system for whiplash associated disorder (WAD)?

A

Quebec task force on WAD

19
Q

What is a grade 0 WAD?

A

no complaints, no physical signs

20
Q

What is a grade 1 WAD?

A

neck pain/stiffness/tenderness only, no physical signs

21
Q

What is a grade 2 WAD?

A

neck complaint + MSK signs

22
Q

What is a grade 3 WAD?

A

neck complaint + neurologic signs

23
Q

What is a grade 4 WAD?

A

neck complaint + fracture or dislocation

24
Q

What are the common presentations of Whiplash?

A
  • often asymptomatic
  • muscle inj
25
Q

What are the less common presentations of whiplash?

A
  • disc inj
  • ligament inj
  • neuro inj
  • dislocation
  • Fx
  • brain inj
26
Q

What are the radiographic findings of whiplash?

A
  • prevertebral soft tissue abnormalities
  • abnormal vertebral alignment
  • abnormal discs
    (CANNOT BE Dx ON ANY IMAGING)
27
Q

When does maximum tenderness typically occur in patients with whiplash?

A

3 days post-inj, once cortisol and swelling go down

28
Q

What abnormal soft tissue findings of whiplash can be seen radiographically?

A
  • widened prevertebral soft tissues
  • soft tissue emphysema (tracheal & laryngeal injury)
29
Q

What abnormal soft tissue findings of whiplash are not visible radiographically?

A
  • brain inj (contusion, hemorrhage, concussion)
  • cord contusion & hemorrhage
  • muscle inj
30
Q

What signs of laryngeal injury may be seen in a patient with whiplash?

A
  • dysphagia
  • hoarseness
31
Q

What pre-existing factor would make whiplash injuries heal slower?

A

pre-existing degenerative change leading to cord contusion and hemorrhage

32
Q

What radiographic signs of abnormal vertebral alignment may be seen in a patient with whiplash?

A
  • loss of lordosis
  • acute kyphotic angulation
  • widened interspinous space
  • altered flexion patterns
33
Q

What static imaging findings would suggest instability in a whiplash patient?

A
  • localized acute kyphosis
  • interspinous widening >2mm indicative; >1.5x definitive)
  • facet gapping
34
Q

What dynamic imaging findings would confirm instability in a whiplash patient?

A
  • translational instability on flex/ext views (3.5mm translation)
  • angular instability (11+ degrees angular motion compared to adjacent segments)
35
Q

What are the minimal diagnostic series for cervical spine radiographs?

A

AP
lateral
APOM

36
Q

What additional views may be obtained only after standard views have ruled out cervical spine fracture or dislocation?

A

bilateral obliques
flexion/extension laterals

37
Q

What are 3 radiographic signs of abnormal discs in a patient with WAD?

A
  • acute disc widening
  • annular vacuum clefts (trauma/degenerative)
  • vacuum phenomenon (degenerative only)
38
Q

What is the clinical significance of acute disc widening?

A
  • alarm finding
  • significant disc inj
  • severe ligament disruption
39
Q

What are annular vacuum clefts?

A

traumatic avulsion of the annulus d/t hyperflexion or hyperextension inj, which may represent instability

40
Q

What is vacuum phenomenon?

A

degenerative finding involving the nucleus, appears as dark line (gas formation) in middle of nucleus

41
Q

What is the diagnosis and what are the radiographic findings?

A

Unilateral facet dislocation
- bow tie sign
- ~25% Anterolisthesis

42
Q

What is the diagnosis and what are the radiographic findings?

A
  • 50%+ anterolisthesis
  • NO bow tie sign
  • widened interspinous space

NYCC Bone & Joint (20 decks)

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