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Semester 3 PM Exam 2 > Diagnostic Imaging - Cervical Spine > Flashcards

Diagnostic Imaging - Cervical Spine Flashcards

1
Q

Standard views for initial visit w/o trauma

A

Ap and lateral

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2
Q

Standard if trauma is involved

A

Open mouth
Oblique (l and r)
Swimmers

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3
Q

Position of patient

A

Done with patient in upright position - shows effect of gravity on the spine but some circumstances this may be dangerous

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4
Q

Ap projection patient position

A

Standing but is most typically done in supine

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5
Q

AP projection - central ray is projected

A

in upward direction about 20 degrees just below the thyroid cartilage

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6
Q

AP projection - thyroid will be

A

black - filled with air

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7
Q

AP projection - clavicles

A

Distorted - tend to be magnified due to distance away from film - appear large and wide

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8
Q

Lateral projection - what do you see

A 
All 7 vertebrae
SP C2-C7
Post arch C1
Intervertebral space 
Facet joints
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9
Q

Lateral projection provides a great deal of info regarding

A

alignment and stability of the spine

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10
Q

Lateral projection - no trauma patient postion

A

erect

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11
Q

Lateral projection - trauma - patient position

A

Supine

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12
Q

What is easy to mistake with lateral projection

A

Post arch of C1 for a SP

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13
Q

Lateral projection alignment

A

3 lines that run parallel
Line 1 = ant aspect of bodies
Line 2 = post bodies
Line 3 = Spinolaminar

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14
Q

Lateral projection - ABCs - you should be seeing

A

C1-T1 and if you can’t see T1 then another projection has to be taken

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15
Q

Predental space

A

Distance btw dens and atlas
Adult - 3mm
Chld - no more than 5mm

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16
Q

Open mouth view is

A

an AP that is focused on the AA joint - indicated when the patient presents with a trauma or signs of instability

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17
Q

Open mouth image should include

A

Dens, lateral masses of C1 and C2

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18
Q

Swimmers view is geared towards evaluation of

A

C7 T1 interface

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19
Q

Swimmers view - patient position

A

arm fully abducted - typically the one closes to the receptor
Reverse swimmers view if abduct the other arm
Prone position

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20
Q

Central ray - swimemrs view

A

Central ray laterally through the axilla toward opposite coracoid process

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21
Q

Right and left oblique - what should you see

A

Vertebral bodies and SP
Pedicles
Facet joints
Intervertebral foramina

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22
Q

Oblique projections may be done in situations in which

A

lateral spinal nerve root compression is suspected

Projection is 45 degrees away from the lateral

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23
Q

Oblique projections - central ray

A

is directed at C4 at a 15-20 degree upward angle

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24
Q

Oblique allows for best visualization of

A

Intervertebral foramina

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25
Q

Right oblique will visualize

A

the right intervertebral foramina

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26
Q

DDD - what is it

A

Degenerative disc disease
Begins with changes to IVD
trauma or aging process

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27
Q

DDD - radiographic features of DDD include

A
  1. Dec in IVD space
  2. Osteophytes
  3. Schmorts nodes (lumbar)
  4. vauum phenomenon
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28
Q

DJD - initial fidnings

A

degeneration of the facet joints

Thinning of articular cartialge and bone sclerosis

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29
Q

Radiographic findings for DJD

A
  1. Dec joint space (cuz of facets)
  2. Osteophytes
  3. Subchondral sclerosis
30
Q

Spondylosis

A

degenerative processes

31
Q

Segments that are most susceptible to injury

A

C1-C2 and C6-C7

32
Q

Hyperflexion injuries

A 
Forcing the cervical spine past its available end range of flexion 
Hyperflexion sprain
Wedge fracture
Flexion teardrop
Avulsion fracture
Bilateral facet joint dislocation
33
Q

Hyperflexion sprain

A

AKA anterior subluxation
Occurs when post ligaments rupture
Considered to be stable because ant and midd columns stay n tact

34
Q

Radiographic features - hyperflexion sprain

A

Loss of normal curvature
Ant displacement of vertebral body
Inc interspinous distance

35
Q

Wedge fracture

A

Greater than 3mm height diff btw the ant and post aspect of the vertebrae indicates fracture
Considered stable if post ligaments remain intact and unstable if not

36
Q

Radiographic features - wedge fracture

A

Dec ant vertebral body height
Inc ant concavity
Inc bone density in area compressed

37
Q

Stable vs. Unstable fracture

A

Fractures in C3-T1 that only disrupt one column are more stable
More than one column disrupted is unstable
C1 C2 doesnt follow this though

38
Q

Flexion teardrop

A

More common and more severe fractures
Force needed to produce it will likely also cause neuro damage
Considered unstable - disrupt all 3

39
Q

Mechanism of injury - flexion teardrop

A

Hyperflexion with compression - like diving into shallow water

40
Q

Flexion teardrop - radiographic findings

A

Teardrop fragment ant inf portion of vertebral body which is displaced in ant direction
Widening of interspinous process
Cervical kyphosis
Post displacement of verebral body compressing spinal cord

41
Q

Avulsion fracture

A

Usually involves act of lifting heavy load with arms extended and a flexed spine position
Considered a stable frcture
C6/C7 are most common

42
Q

Avulsion fracture of SP AKA

A

Clay Shovelers fracture

43
Q

Bilateral facet dislocation

A

Dislocations of C3-C7 can occur with or without fracture

44
Q

Bilateral facet dislocation - casue

A

A fracture of post portions of veretbrae and disruption of post ligaments is cause

45
Q

Bilateral facet dislocation - stable or unstable

A

highly unstable - will tend to cause spinal cord injury

46
Q

Bilateral facet dislocation - radiographic findings

A

Ant translation of vertebrae
Widened interspinous space
Locked facet joint
Prevertebral soft tissue edema

47
Q

Hyperextension injuries

A

Hyperextension spain
Extension teardrop fracture
Hangman’s fracture

48
Q

Hyperextension sprain

A

Ant ligaments are disrupted causing post translation of vertebrae - post subluxation

49
Q

Extension teardrop

A

Forced neck extension produces an avulsion fracture of the anterioinferior portion of the vertebral body
Diving accidents = common cause
ALL is forcibly stretched avulsing a piece off the vertebrae

50
Q

Extension teardrop - stable vs unstable

A

During active motion the fracture is stable in flexion and highly unstable in extension
Most often involves C2

51
Q

Hangmans fracture

A

Results when hyperextension and distraction are applied
AKA traumatic spondylolisthesis of C2
Bilateral fracture of pars articularis

52
Q

Hangmans fracture - classification

A

Levine Classification

53
Q

Type I hangman

A

Less than 3 mm translation C2 on C3
C2-3 disc is intact
Prevertebral soft tissue edema
Generally stable

54
Q

Type II hangman

A 
More than 3mm translation C2 on C3
C2 C3 disc space disrupted
More than 10 degrees angulation 
PLL rupture
Prevertebral edema
Unstable
55
Q

Type III Hangman

A

All of Type II features plus bilateral facet joint dislocation
Very unstable

56
Q

Extension teardrop radiographic findings

A

Anterior inferior corder fracture (triangular in shape)
Ant disc space widen
Prevertebral soft tissue edema

57
Q

Axial compression

A

Forces that are applied directly though the spine in a vertical direction
Burst fracture
Wedge fracture

58
Q

Burst fracute

A

The compression force with high energy load causes the intervertebral discs to be driven into the vertebral body
Results in vertebral fragmentation and spead to surroudnings tissues
Post cortex of the vertebare is pushed into spinal cord
Comminuted fracture

59
Q

Burst fracture of C1 is known as

A

Jefferson fracture

60
Q

Identification of jeffereson fracture via

A

Open mouth view
CT scan required to see extent of damage
C1 is ring so if one fracture there is probably another
Unstable if transverse ligament is involved

61
Q

Radiographic findings for jefferson

A

Lateral masses are split and overhang C2

If greater than 7mm the transverse ligament is ruptures

62
Q

AA dislocation - disorders that can lead to laxity

A

RA and Down Syndrome

63
Q

OA dislocation - mechanism

A

typically hyperextension with distraction
Seen most often in children - rupture of ligaments that stabilize occ on atlas
Highly unstable and can result in death or neuro impair

64
Q

Dens fracture

A

AKA peg fractures

Open mouth and CT scan recommended

65
Q

Unilateral Facet dislocation - mechanism

A

hyperflexion and rotation
Facet capulse and post ligaments on one side are disrupted
Cuases the sup facet to move over the inf facet and lock into place

66
Q

Radiogaphic findings for unilateral facet dislocation

A

Inc interspinous distance
Ant translation of vertebral body
Bow tie effect - lateral masses overlap

67
Q

Dens fracture classification system

A

Anderson and D Alonzo

68
Q

Type 1 dens fracture

A

tip of dens is avulsed
Fracture site is above trans lig so is stable
Less then 8% of dens fracture

69
Q

Type 2 dens fracture

A

common
Occurs through base of dens
hard to heal and high degree of non-union
Unstable

70
Q

Type 3 dens fracture

A

location across lateral masses and base of dens has better chance of healing than type II

Semester 3 PM Exam 2 (4 decks)

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