Imaging-C-Spine Flashcards
A 25 year old male is brought to the ER on a back board with a cervical collar in place. He says he has no neck pain. His BAC is 0.2. What is your next step?
He has a higher BAC and depending on his injury type is at higher risk for injury so you probably wouldn’t do a plain film. You would do a CT if you suspect bone fracture or and MRI if you suspect ligamentous or cord injury
Why would you have a patient perform the swimmer maneuver when taking an x-ray?
To expose the C-spine all the way down to T1.
What are the different labeled ligaments of the spine seen below?
Anterior longitudinal ligament, posterior longitudinal ligament, tectorial membrane, ligamenta flavum and supraspinousligament.
What cervical ligament extends from the occipital protuberance to C7?
Ligamentum nuchae
What cervical ligaments are shown below?
Apical, Alar, Transverse & Cruciate
How do you start analyzing the c-spine image below?
1) Follow posterior spinous processes 2) Articular pillars and 3) Pedicles looking for symmetry and lucency
How do you start analyzing the c-spine image below?
1) Check alignment (anterior (yellow) & posterior (blue) vertebral lines, spinolaminar line (green), posterior spinous line (pink) and predental space(box)) 2) Look for compressions and fractures in bones 3) Look for clear cord area 4) Disk height 5) Soft tissue
What are the labeled structures seen in the image below?
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In what region of your c-spine image will you look for if you suspect damage to the vertebral artery?
Near the pedicles. These are in the region of the transverse foramen.
A patient comes to see you in clinic with the following radiograph. What is your diagnosis?
This patient has an opacity near the pedicle, which could indicate possible vertebral artery insult.
Where does the spinal cord live?
Posterior to vertebral bodies in the spinolaminar line.
What are the structures indicated below? What do you look at when making sure there is not a pathology in this area?
1) Axis 2) Atlas. You look to make sure that lateral masses are aligned and that all spaces are symmetrical.
How do you test for atlanto-axial instability?
You take flexion and extension radiographs, looking for movement of the dens in the different images that might indicate weakness of the cruciate transverse ligament
What are the two categories of c-spine fractures?
Craniocervical (AO, occipital condyle, C1, C2, and AA) and subaxial (hyperflexion, hyperextension and vertical compression injuries)
How do radiologists determine if a patient has an unstable spine or not?
Two of three of the categories seen below are achieved. Vertebral compressions, anterolisthesis, widening or narrowed discs, widened interspinous spaces.
What is your diagnosis?
Wedge fracture (flexion). Note bright signal (edema) and loss of vertebral height.
What is your diagnosis?
Flexion teardrop. This happens when the corner of the lower vertebra impacts the anterior inferior margin of the upper vertebra, for example when diving into a shallow swimming pool. These are the 2nd most serious injuries.
What is your diagnosis?
Bilateral facet dislocation (flexion). Note the anterior vertebral line is disrupted and the superior articular process has slipped posteriorly.
What is your diagnosis?
Clay shoveler’s fracture (flexion). Note the fracture in the posterior spinous process. C7 is most common from powerful hyperflexion with paraspinous muscle contraction.
What is your diagnosis?
Unilateral facet dislocation (flexion). Note the inferior articular process has slightly subluxed over the superior articular process of the lower vertebra. This happens with simultaneous flexion & rotation.
What is your diagnosis?
Atlantoaxial Rotary Fixation. Note the fixed enlargement in the C1-C2 space (test further when the patient looks, left, right, and forward).
What is your diagnosis?
Hangman’s fracture (extension). Note the fracture of the pars interarticularis. This often happens with hyperextension & distraction (when a chin hits the dashboard during a MVA).
What is your diagnosis?
Extension teardrop. Note the little fleck of bone anteriorly from avulsion of the anterior longitudinal ligament during hyperextension.
What is your diagnosis?
Jefferson fracture (compression injury). This is a disruption of the transverse ligament and fracture of C1 ring. Note that the C1 left lateral mass has been displaced from C2 and the C1-C2 space is widened. This happens with axial blows to the head as in diving into a shallow swimming pool.
What is your diagnosis?
Burst fracture (compression). This occurs as a result of axial compression.
What is your diagnosis?
AO Dislocation (hyperextension). Note the cervical spine has been completely shifted posteriorly from the occipital condyles. This is usually fatal due to spinal cord transection.
What is your diagnosis?
Occipital condyle fracture.
What is your diagnosis?
Type II odontoid fracture through the base of the dens. Note the C2 vertebral body has a transverse fracture.
What do you need to keep in mind when diagnosing someone with a dens fracture?
Mach line (below) and the os odontoideum (secondary ossification center)
