Neutral Lateral Cervical Flashcards
1
Q
Soft tissue front of spine
A
Retropharyngeal - C4 - 7mm
Retrolaryngeal space - 14mm
Retrotracheal space - C6 - 21/22mm
2
Q
If soft tissue is larger than vertebral body
A
Soft tissue swelling due to trauma, infection, malignancy
3
Q
ADI space
A
Normal ADI 1-3mm adult
4
Q
If ADI is the size of the anterior tubercle
A
Increased ADI - transverse ligament laxity
Brace the neck and refer out
5
Q
Compare spinolaminar of C1 to C2
A
Atlas moved anterior or posterior
6
Q
Atlas moved anterior
A
Increased ADI
Fractured dens
Non-union of the dens
Agenesis of the dens
7
Q
Atlas moved posterior
A
Fractured dens
Non-union of the dens/unstable odontoidium
Agenesis of the dens
8
Q
Check the front of the bodies
A
Syndesmophytes
Hyperostosis
Lipping/spurring
9
Q
Marginal syndesmophytes
A
AS
Pushed up against front of the vertebral bodies and disc space
BILATERAL
10
Q
Non-marginal syndesmophytes
A
Reactive arthritis - +STD panel, vinereal disease, arthritis, iritis, conjunctivitis, urethritis
PA - silver scales, pitted nails, cocktail sausage digits
11
Q
AS aka
A
Marie strumpell’s disease
12
Q
AS about
A
Most commonly males 15-35
LBP with morning stiffness
Iritis/uveitis
13
Q
AS orthos
A
Chest expansion
Forrestier’s bowstring
Lewin’s supine
14
Q
Radiographic signs AS
A
Bilateral SI joint fusion - ghost joints/star sign
Erosion of vertebral corner - Romanus lesion
Spine - shiny corner sign, bilateral marginal syndesmophytes, thin eggshell calcif around disc, squaring of vertebral bodies, bamboo spine, dagger sign, trolley track sign, poker spine, andersson lesion
15
Q
AS labs
A
+HLA-B27
-Rheumatoid
+ESR
16
Q
Case management AS
A
Co-treat with Rheumatologist
Can adjust but avoid areas that are actively inflamed or involved
17
Q
Non-marginal syndesmophytes description
A
Flows out into the soft tissue (unilateral or bilateral)
Reiter’s disease
PA
18
Q
Reiter’s disease aka
A
Reactive arthritis
Vinereal disease
19
Q
Reiter’s description
A
20-30 Conjunctivitis Urethritis Iritis Arthritis Ulcers on feet Apthous stomatitis Calcaneal spur (lover’s heel)
20
Q
Reiter’s caused by
A
Chlamydia
21
Q
Reiter’s labs
A
HLAB27
+STD panel
22
Q
REiter’s is like DISH but
A
Facets are fused
23
Q
Case management reiter’s
A
Refer to PCP or Rheumatologist
24
Q
PA description
A
20-50 Silver scaly lesions on extensors Pitted nails Cocktail sausage digits Auspitz sign
25
Lab PA
HLA B27
| -Rheumatoid
26
Case management PA
Refer to Rheumatologist
27
DISH aka
Anterior spinal bridging
| Exostosis of 4 or more segments
28
Hyperostosis
| Candle wax drippings
DISH
29
DISH description
Males >40
Neck stiffness
Pain on swallowing
30
Radiographic findings DISH
```
Flowing hyperostosis
Candle wax drippings
4 continuous segments involved
Disc space preserved
Facets preserved
```
31
Long-term DISH
Postural deformity and loss of proper motion - early onset DJD
32
DISH associated with
Diabetes mellitus - eye exam and labs for diabetes
33
DISH can cause ossification of the
PLL
34
Case management DISH
Endocrinologist referral
Orthopedist referral
You can adjust but no audibles
35
Lipping and spurring
DJD
| Infection
36
DJD
Ant vertebral body comes out to meet like pursing lips
Lipping and spurring (osteophytes)
Decreased disc space
Subchondral sclerosis of endplates
37
Usually stiffens with rest and improves with activity
DJD
38
DJD complications
Spinal stenosis
| IVF encroachment
39
Only condition that alters the disc space in size and/or color and affects the surrounding endplates
Infection
40
Pt presents with a fever, chills, possible hx of trauma/surgery, and a warm, tender, swollen joint
Infection
41
Infection case management
Refer out
Chest x-ray
Sputum culture
WBC count
42
Avulsion fractures aka
Teardrop fracture
43
Avulsion fracture
Avulasion of the anterior inferior aspect of the vertebral body from a hyperextension trauma/whiplash
44
Avulsion fracture associated with
Acute anterior cervical cord syndrome
| Loss of motor, pain, and temperature
45
Avulsion fractures are most common in
Cerivcal spine
| Most commonly seen at C2
46
Case management avulsion fracutre
Flex/ext
| Immediate referral for orthopedic surgical consult
47
Compression fracture
Loss of 25% or more body height
| MOP IT
48
MOP IT
```
Malignancy
Osteoporosis
Pagets
Infection
Trauma
```
49
Malignancy
Destroys both ant and post body height
50
Osteoporosis
Only ant body height destroyed - esp thoracic
51
Infection
Fever
| WBC
52
Trauma
Hx trauma
53
Check the base of the dens for a radiolucent line
Fractured Dens
Non-union of the dens (os odontoidium)
Agenesis of the dens
Mach line
54
Fractured dens
```
Bone displaced from itself
Jagged edges
Acute
Hx trauma
Pain
THIN
DISPLACEMENT
```
55
Non-union of the dens (os odontoidium)
```
Smooth edges
Cortical margins around united pieces
Chrnoic
No displacement
No hx trauma - usually asymptomatic
Anterior tubercle gets white
Smooth edges
THICK lines
REFER orthopedist
```
56
Agenesis of the dens
Missing ADI
| Color of where dens should be is similar to the color of the C2 body
57
Mach line
Rule out other three - fractured dens, non-union of the dens, agenesis of the dens
58
Approximate the dens for
Height
Alignment
Color
59
Height dens
Majority of dens should be below base of occiput - if not = basilar invagination - paget’s fibrous dysplasia, tauma
Similar to height of C2 body
60
Mensuration lines height dens
McGregor’s
| Chamberlains
61
McGregors
Back of hard palate to base of occiput
8mm male
10mm female
62
Chamberlains
Back hard palate to posterior foramen magnum
| No more than 7mm above line
63
Alignment dens
```
Should be in line with C2 body - no = fx
Jagged and displaced
Brace the neck
Refer to orthopedic surgeon
Leaning dens = sign of fx or os but usually fx
```
64
Color dens
Color of where dens is should be whiter than the body
| If dens is missing color is similar to C2 body
65
Check the bodies for alterations of color and shape
Color - darker/lighter
| Shape - PFC
66
Color darker
Lytic mets
| Multiple myeloma
67
Multiple myeloma aka
Plasma cell sarcoma
68
Multiple myeloma description
```
Aplastic anemia
Thrombocytopenia
>50
Weight loss
Anemia
Chachexia
Plasma cell leukemia
Bone pain worse at night
Nothing palliative/provocative
```
69
Most common primary malignancy in adults
Multiple myeloma
70
Multiple dark densities that are similar in size (punched out lesions) in extremities
Can cause pathological collapse (vertebra plana)
Mm
71
Rain drop skull
Multiple myeloma
72
Labs mm
```
Reversal of AG ratio
IgM spike on immune-electrophoresis
Bence jones proteinuria
ESR
Aplastic anemia aka normochormic normocytic anemia
```
73
Special test mm
COLD on bone scan
| Refer to oncologist
74
Pathological compressions
Vertebrae plana
| Dec in post body height but will spare the pedicles (lytic mets will not)
75
Lytic mets
```
Signs of malignancy
>40
Recent unexplained weight loss
Skeletal pain worse at night
Cachexia
Nothing palliative/provocative
```
76
Lytic mets description
Moth eaten or permeative pattern of destruction - all holes different sizes
Eats away bone
Eats pedicles
Vertebra plana, winking owl, swiss cheese appearance
77
Lab lytic mets
Alkaline phosphatase
78
Special test lytic mets
HOT on bone scan - destruction will be hottest part
79
Whiter color bodies
Hodgkin’s
Blastic mets
Paget’s
80
Hodgkins
Cervical only
Cortical thickening/enlargement/deformity
Most common form of mets in ages 20-30
81
Ivory white vertebrae with anterior body scalloping
| Unilateral hilar lymphadenopathy in white males seen on PA chest view
Hodgkin’s
82
Confirm hodgkin’s by
Biopsy
| Reed sternberg cells
83
Blastic mets
Obviously whiter but not bigger
>40
Ivory white vertebrae no cortical thickening or enlargement
84
Labs blastic mets
Increased alkaline phosphatase
85
Special test blastic mets
Bone scan
86
Paget’s aka
Osteitis deformans
87
Paget’s
Male >50
88
```
Causes cortical thickening
Picture frame vertebrae
Increased bone density
Coarsened trabeculae
Bone enlargement
Basilar invagination
```
Paget’s
89
Labs paget’s
Increased alkaline phosphatase
| Urinary hydroxyproline
90
Special test paget’s
Bone scan
91
Alteration of shape
PFC
92
PFC
Paget’s
Fractures
Congenital
93
Paget’s
Cortical thickening
Enlargement
Deformity
94
Fractures
Loss of anterior body height 25% or more
| Vertebral plana - pathological collapse = loss of both anterior and posterior body height
95
Most common cause fx
Mm
| Mets
96
Congenital anomalies
Congenital block
| Klippel-feil syndrome
97
Congenital block
Two segments fused together from birth
Wasp waise appearance
Hypoplastic disc/rudimentary disc/remnant disc
Fusion posterior aspects
98
Klippel-feil syndrome
Multiple congenital blocks
Sprengle’s deformity
Omovertebral bone - calcification of the rhomboids
99
DJD aka
DDD
Spondylosis
Arthritis
100
Lipping and spurring (osteophytes)
Decreased disc space
Subchondral sclerosis of endplates
Vacuum phenomenon
DJD
101
Vacuum phenomenon aka
Knuson’s phenomenon
IVOC
Phantom disc
102
Infection aka
```
Infective arthritis
Infective spondylitis
Septic arthritis
Osteomyelitis
Pott’s disease
```
103
Check the posterior arch of atlas
Missing
| Vertical radiolucency
104
Missing posterior arch atlas
Surgery
Malignancy
Agenesis
105
Missing post arch C1 - surgery
Must see signs of surgery on film like staples, wires
106
Missing post arch C1 - malignancy
M/c lytic mets teeth marks/jagged
107
Missing post arch C1 - agenesis
Smooth borders
Clean margins
Enlargement
Whiter ant tubercle
108
Vertical radiolucency post arch atlas
Fracture
| Non-union
109
Check teh pedicles of C2 for fractures
Hangman’s fracture - bipedicular fracture - posterior type 4 spondylolisthesis
Hyperextension trauma - whiplash
110
Posterior bodies - height and destruction
Decreased ant and post = pathological fx
Teeth marks in bone = lytic mets
MOP IT
111
Pathological fx
Vertebral plana
Pancake vertebrae
Wafer thin vertebrae
Coin on end vertebrae
112
Pedicles
Check for slipping bodies - subluxation or dislocation
113
Slippage of VB ant or post by 10-15% with facets still lining up
Break in George’s line
Subluxation pedicles - slipping bodies
114
Slippage of the vertebral body ant or post by 25% or more with face perching and spinous fanning
Brace the neck
Refer to orthopedic surgeon/ER
Pedicle - dislocation
115
Facets
Dislocation
Destruction
Fusion
116
Dislocation facets
Trauma or ligament instability
117
Destruction facets
Facet arthrosis whiter in facet area - teeth marks - rat bite erosinos in RA
118
Fusion facets
Congenital or acquired
119
Congenital fusion facets
Two facets fused as one - megaspinous with one spinolaminar line
120
Acquried fusion facets
Facets fused with separate distinct spinal laminar lines
| RA or AS
121
Two conditions cause acquired fusion of the facets
AS - marginal syndesmophytes and thin eggshell calcification
| RA - only affects synovial joints
122
Check spinolaminar lines and spinouses
Congenital surgical malignancy
123
Fractures
Bone displaced from itself
C6,C7, T1
Clay shoveler’s fractures
Hyper-flexion trauma
124
Double spinous sign seen on AP view
Spinous fx
125
Missing spinolaminar line is a
Spina bifida on the lateral view
B9 deficiency
C1 = spondyloschisis
