L21 radiographic spinal anatomy & spinal trauma Flashcards
Define the term spinal trauma
- damage to the spinal cord resulting from trauma or from disease or degradation
where in the spine does the trauma most commonly occur?
- mostly occurs at the level of C5,C6 and C7 due to the greatest mobility at these levels
what is hyperextension & give an example of a situation that could result in this?
- excessive posterior movement of the head or neck
- example situation - elderly person falling to the floor
what is hyperflexion & give an example of a situation that could result in this?
- hyperflexion is excesive anterior movement of head onto chest
- example situation - a rider thrown off their motor cycle
what is compression?
- when the weight of head or pelvis driven into stationary neck or torso
How could rotation cause spinal injuries?
excessive rotation of the torso, head and neck, moving one side of the spinal column against the other
what is a lateral stress injury?
- direct lateral force on the spinal column
what is distraction in terms of spinal injuries?
excesive stretching of column and cord
Describe the presentation of a patient with spinal trauma
- 1/3 of spinal trauma patients are symptomatic
- medications or intoxications can mask important clinical features
- spinal cord injury** causes neurological symptoms**
- the severity of the consequences depends on the location / level of injury
Describe the symptoms of C spine trauma
- loss of muscle function or strength
- often requires mechanical breathing assistance as chest muscles may also be weakened
Describe T/L spine trauma
- paralysis and loss of function in the legs and lower body- paraplegia
what type of paralysis do injuries above C4 cause?
diaphragm paralysis
what organs can injuries above T2 affect?
- this effects the innervation of the heart - leading to impaired left ventricle function and risk of severe bradycardia
what happens as a secondary response to spinal injury?
spinal shock - loss of reflex, motor and sensory function below a spinal cord level
what type of radiography is used initially to check spinal trauma?
X-ray - checks for alignmnt and fractures in symptomatic patients
How should the spine line up in an X-ray image?
- vertebral bodies should line up with a gentle arch- lordosis
- each body should be rectangular in shape and roughly equal in size
- the anterior and posterior heights should be equal
how should the disc spaces look on the X ray?
normal vs older patients?
- disc spaces should be roughly equal in height at all levels
- however in older patients, degeneration may lead to spurring and loss of disc space
- disc spaces should be symmetric
what important clinical feature does an xray allow us to see in spinal trauma?
- pre vertebral soft tissue swelling
- swelling may be due to haematoma formation secondary to the fractures
what is a jefferson fracture?
fracture of C1
what is a hangman fracture?
- fracture of the pedicles in C2
how many types of Dens fractures are there?
type I, II & III
what is a hyperflexion teardrop fracture?
- fracture of the anteroinferior aspect of of a cervical vertebral body
- caused by flexion of the spine
- most commonly occur at the mid/lower cervical spine
what are ‘peg’ fractures?
- fractures of the dens (odontoid process) of C2
- happens as a result of neck extension or compression in a high velocity accident or severe fall
How are type I, II and III fractures of the odontoid classified?
- Type I - fractures of the upper part of the odontoid process
- type II - fractures at the junctions of the odontoid process and the body of axis
- type III- fractures through the body of the axis
