Radiological Eval of C-Spine

Question 1

ABCDs of MRI for C-spine: B= Bone density

• Assess for irregular signal intensities signifying ____ or _____ that may be localized or an extension from adjacent tissue

Answer 1

disease or infection

Question 2

Trauma to the Cervical Spine: Stable or Unstable

• compression fractures, disc herinations that do not invade central canal or foramen

Answer 2

Stable

Question 3

ABCDs of MRI for C-spine: C = ___

1. Observe the size of the ___, which is normally widely patent (open)
2. Contents of the ___ = spinal cord, nerve roots, cerebrospinal fluid => can be assessed
3. Look for any ____ (indentation from an ajacent structure) of the thecal sac

Answer 3

C = canal space

1. spinal canal
2. thecal sac
3. effacement

Question 4

ABCDs of CT for C-spine

• Coronal and sagittal reformats are best for assessing normal spinal ____ or deviaations in _____ that signal fracture, dislocation, or bone destruction.

Answer 4

alignment

Question 5

Trauma to the Cervical Spine

• In an emergent situation, which type of imaging is preferred given potential complexity of anatomy?

Answer 5

CT

• will screen more
• relatively cheap, short, and greater access than MRI

Question 6

Two types of fractures charateristic of the cervical spine:

1. ___ = can see secondary to spinous ligament sprain
2. ____ = wedge, impacted, or burst

Answer 6

1. Avulsion
2. Compression

Question 7

For MRI, which image plane demonstrates the following structures for evaluation:

• vertebral bodies, endplates
• disc signal, disc height
• subarachnoid space
• spinal canal, spinal cord
• anterior and posterior longitudinal ligaments
• interspinous and supraspinous ligaments
• spinour processes

Answer 7

Sagittal plane

Question 8

Both DDD and DJD can cause degenerative changes in the surrounding structures including ____ and ____.

Answer 8

Foramen and central canal

Question 9

Trauma to the Cervical Spine: Stable or Unstable

• fracture dislocations, facet dislocations

Answer 9

Unstable

Question 10

In a CT sagittal evaluation of the C-spine:

1. Assess vertebral body alignment via 3 lines drawn connecting ___, ____, and _____
2. ___ indicate fracture, subluxation, or dislocation

Answer 10

1. anterior vertebral bodies, posterior bodies, and spinolaminar conjuction
2. Step-offs

Question 11

DDD can lead to:

1. vertebral endplate ____
2. Increased ____ changes at joints
3. Stenotic changes at ____ and ____

Answer 11

1. approximation
2. stenotic
3. vertebrae and discs

Question 12

In a coronal evaluation of the C-spine:

• assess normal ____ relationship

Answer 12

craniovertebral

Question 13

Trauma to the Cervical Spine: Stable or Unstable

• can be treated with bracing and rest => no immediate risk to central canal

Answer 13

Stable

Question 14

What are the 5 types of routine series of radiographs for the C-Spine (which types of views)?

Answer 14

1. AP Open Mouth
2. AP lower c-spine
3. lateral
4. Right Oblique
5. Left Oblique

Question 15

In a CT C1/C2 axial evaluation:

1. Position of the dens to the anterior arch of ___ to the lateral masses of __
2. The ___ interface
3. Steel’s Rule of thirds

Answer 15

1. atlas, C1
2. atlantodental
3. Steel’s Rule of thirds
   
   1. AP diameter ring of atals = 3 cm
   2. dens and spinal cord each = 1 cm, taking up 2/3rds of the ring
   3. remaining 1 cm of free space allows for some ?

Question 16

For MRI, which image plane demonstrates the following structures for evaluation:

• IV discs
• nerve roots
• intervertebral foramina
• spinal canal, epidural space, thecal sac
• facet joint
• ligamentum flavum

Answer 16

Axial Plane

Question 17

Which type of C-spine view assesses the following:

• ABC’s
• IV foramina are seen individually (IMPORTANT)
• Both R and L views are made

Answer 17

Oblique View (Right and Left)

On image

• A = foramina

Question 18

Degeneration of the Cervical Spine

1. DDD = ___
2. DJD =____
3. ____ stenotic changes
4. ___ ___ stenotic changes

Answer 18

1. Degenerative Disc Disease
2. Dengenerative Joint Disease
3. Foraminal
4. Central Canal

Question 19

ABCDs of MRI for C-spine

• Sagittal is best for assessing normal spinal ___ or deviatins that signal fracture, dislocation, or destruction of bone.

Answer 19

alignment

Question 20

Which type of C-spine view assesses the following:

• ABC’s
• 3 parallel lines
• IV disc spaces
• Atlantodental interspace
• Retropharyngeal space < 7mm
• Retrotracheal Space 14 mm kids, 22mm adults

Answer 20

Lateral View

On image

• 3 parallel lines
  
  • Lines 1,2,&3 are useful for appreciating alignment
  • abnormal presentations include spondylotisthesis
• b = IV disc spaces
• c= atlantodental interspace
• d= retropharyngeal space
• e = retrotracheal space

Question 21

For MRI, which imaging view will assess for the following at the C-spine:

• abnormal soft tissues
• abnromal vertebral alignment
• abnormal joint relationships

Answer 21

Lateral View

Question 22

ABCDs of CT for C-spine: D= disc integrity

1. Evaluate the ___ and ___ margins on axial views for contour and intact bodies.
2. ___ will alter the posterior contour.

Answer 22

1. Posterior and posterolateral
2. Herniated Discs

Question 23

ABCDs of MRI for C-spine: s = soft tissue

1. examine the paravertebral soft tissues for presence of ____ due to truama, primay neoplasmss, infection, or extension of masses
2. Inspect the integrity of the ligaments and ____ following truama

Answer 23

1. edema
2. spinal cord

Question 24

Stenosis (i.e, spondylosis and osteo.), schmorl’s nodes, and vacuum phenonmenon = ______, such as with DDD

Answer 24

stenotic changes

Question 25

Avulsion fractures, compression fracture, and wide spinous process secondary to an MVA are all examples of ____ injury to the cervical spine.

Answer 25

Hyperextension

Question 26

Trauma to the Cervical Spine: Stable or Unstable * immediate serious risk to spinal cord or nerve root =\> will need surgical intervention to repair

Answer 26

Unstable

Question 27

ABCDs of CT for C-spine: B = bone density 1. Assess for ___ signfying disease or infection 2. Assess for breaks in the ____ which are fractures * Note; cortical bone = most dense and cancelleous bone = less dense

Answer 27

1. destruction 2. cortical margins

Question 28

ABCDs of MRI for C-Spine: D = disc 1. evaluate disc ___ and ____ of the nucleus pulposus 2. Evaluate the ____ margins on sagittal views and ____ margins on axial views for contour and intact boarders

Answer 28

1. disc height, hydration of the nucleus pulposus 2. posterior = sagittal, posterolateral = axial

Question 29

ABCDs of CT for C-spine: C =\_\_\_\_ 1. Assess the ____ space on axial views for latency 2. Look for encroachment on the ____ or lateral recesses that may cause neural impingement 3. Identify any ____ that may have migrated to the canal from a fracture or an extruded disc

Answer 29

C= Canal Space 1. spinal canal space 2. central canal 3. free fragments

Question 30

Which type of C-spine view assesses the following: * ABC's * C1-C2 symmetry * Dens Midline between the lateral masses of C1 * C2 vertebral body * C2 spinous process

Answer 30

AP Open Mouth: cervical on image * lateral masses of C1 = a * C2 vertebral body = e

Question 31

ABCDs of CT for C-spine: s = soft tissue * Examine the ___ soft tissues on the sagittal format for presence of edema due to \_\_\_.

Answer 31

1. pre-vertebral 2. trauma

Question 32

The value of CT for the spine is in the ___ of \_\_\_.

Answer 32

depiction of bone

Question 33

Cervical Spine Sprains 1. severity can range from minimal involvment to _____ to concurrent symptomology like compression fractures 2. ____ sprain = traction injury to anterior tissues and compression of posterior 3. ____ sprain = traction injury to posterior tissues and compression to anterior

Answer 33

1. subluxation 2. hyperextension 3. hyperflexion

Question 34

Which type of C-spine view assesses the following: * segmental stability at EROM

Answer 34

Stress Views * Lateral View (with flexion) * Lateral View (with extension) On image * Preservation of spatial realtionship of 3 parallel lines * constant width of atlantodental interface

Question 35

Degenerative Disc Disease (DDD) * ___ in Disc Height, associated with 1. \_\_\_\_ 2. nuclear \_\_\_\_ 3. annular \_\_\_\_

Answer 35

Decrease in disc height 1. dehydration 2. nuclear herination 3. annular protrusion

Question 36

CPG: Canadian C-Spine Rules for Cervical Imagaing Patients should have radiography if 1. Dangerous \_\_\_ 2. \>\_\_\_ years old 3. \_\_\_\_ 4. Midline \_\_\_\_\_ 5. unable to rotate \_\_\_

Answer 36

1. Dangerous MOI 2. \>65 years old 3. Paresthesias 4. Midline tenderness 5. Unable to rotate 45^o

Question 37

The value of MRI for the spine is in the depiction of \_\_\_, \_\_\_, and \_\_\_\_.

Answer 37

spinal cord, disc, and nerves

Question 38

Which type of C-spine view assesses the following: * ABC's * C3-C7 * C2-C3 IV disc space * T1 ribs * Spinous processes * Pedicles equidistant

Answer 38

AP Lower C-spine On image * B = midline of spinous processes * A = uncinate processes (pedicles equidistant)

Question 39

Abnromal vertebral alignment and joint relationships could be impacted (but not limited to) sprains, \_\_\_\_, burst fractures, ____ injuries

Answer 39

Sprains, fractures, burst fractures, compression injuries

Question 40

Degenerative Joint Disease (DJD) * Osteoarthritic changes at the \_\_\_\_, which can impact multiple levels

Answer 40

facets