Radiological Eval of C-Spine Flashcards
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
disease or infection
Trauma to the Cervical Spine: Stable or Unstable
- compression fractures, disc herinations that do not invade central canal or foramen
Stable
ABCDs of MRI for C-spine: C = ___
- Observe the size of the ___, which is normally widely patent (open)
- Contents of the ___ = spinal cord, nerve roots, cerebrospinal fluid => can be assessed
- Look for any ____ (indentation from an ajacent structure) of the thecal sac
C = canal space
- spinal canal
- thecal sac
- effacement
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.
alignment
Trauma to the Cervical Spine
- In an emergent situation, which type of imaging is preferred given potential complexity of anatomy?
CT
- will screen more
- relatively cheap, short, and greater access than MRI
Two types of fractures charateristic of the cervical spine:
- ___ = can see secondary to spinous ligament sprain
- ____ = wedge, impacted, or burst
- Avulsion
- Compression
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
Sagittal plane
Both DDD and DJD can cause degenerative changes in the surrounding structures including ____ and ____.
Foramen and central canal
Trauma to the Cervical Spine: Stable or Unstable
- fracture dislocations, facet dislocations
Unstable
In a CT sagittal evaluation of the C-spine:
- Assess vertebral body alignment via 3 lines drawn connecting ___, ____, and _____
- ___ indicate fracture, subluxation, or dislocation
- anterior vertebral bodies, posterior bodies, and spinolaminar conjuction
- Step-offs
DDD can lead to:
- vertebral endplate ____
- Increased ____ changes at joints
- Stenotic changes at ____ and ____
- approximation
- stenotic
- vertebrae and discs
In a coronal evaluation of the C-spine:
- assess normal ____ relationship
craniovertebral
Trauma to the Cervical Spine: Stable or Unstable
- can be treated with bracing and rest => no immediate risk to central canal
Stable
What are the 5 types of routine series of radiographs for the C-Spine (which types of views)?
- AP Open Mouth
- AP lower c-spine
- lateral
- Right Oblique
- Left Oblique
In a CT C1/C2 axial evaluation:
- Position of the dens to the anterior arch of ___ to the lateral masses of __
- The ___ interface
- Steel’s Rule of thirds
- atlas, C1
- atlantodental
- Steel’s Rule of thirds
- AP diameter ring of atals = 3 cm
- dens and spinal cord each = 1 cm, taking up 2/3rds of the ring
- remaining 1 cm of free space allows for some ?
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
Axial Plane
Which type of C-spine view assesses the following:
- ABC’s
- IV foramina are seen individually (IMPORTANT)
- Both R and L views are made
Oblique View (Right and Left)
On image
- A = foramina
Degeneration of the Cervical Spine
- DDD = ___
- DJD =____
- ____ stenotic changes
- ___ ___ stenotic changes
- Degenerative Disc Disease
- Dengenerative Joint Disease
- Foraminal
- Central Canal
ABCDs of MRI for C-spine
- Sagittal is best for assessing normal spinal ___ or deviatins that signal fracture, dislocation, or destruction of bone.
alignment
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
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
For MRI, which imaging view will assess for the following at the C-spine:
- abnormal soft tissues
- abnromal vertebral alignment
- abnormal joint relationships
Lateral View
ABCDs of CT for C-spine: D= disc integrity
- Evaluate the ___ and ___ margins on axial views for contour and intact bodies.
- ___ will alter the posterior contour.
- Posterior and posterolateral
- Herniated Discs
ABCDs of MRI for C-spine: s = soft tissue
- examine the paravertebral soft tissues for presence of ____ due to truama, primay neoplasmss, infection, or extension of masses
- Inspect the integrity of the ligaments and ____ following truama
- edema
- spinal cord
Stenosis (i.e, spondylosis and osteo.), schmorl’s nodes, and vacuum phenonmenon = ______, such as with DDD
stenotic changes
Avulsion fractures, compression fracture, and wide spinous process secondary to an MVA are all examples of ____ injury to the cervical spine.
Hyperextension
Trauma to the Cervical Spine: Stable or Unstable
- immediate serious risk to spinal cord or nerve root => will need surgical intervention to repair
Unstable
ABCDs of CT for C-spine: B = bone density
- Assess for ___ signfying disease or infection
- Assess for breaks in the ____ which are fractures
- Note; cortical bone = most dense and cancelleous bone = less dense
- destruction
- cortical margins
ABCDs of MRI for C-Spine: D = disc
- evaluate disc ___ and ____ of the nucleus pulposus
- Evaluate the ____ margins on sagittal views and ____ margins on axial views for contour and intact boarders
- disc height, hydration of the nucleus pulposus
- posterior = sagittal, posterolateral = axial
ABCDs of CT for C-spine: C =____
- Assess the ____ space on axial views for latency
- Look for encroachment on the ____ or lateral recesses that may cause neural impingement
- Identify any ____ that may have migrated to the canal from a fracture or an extruded disc
C= Canal Space
- spinal canal space
- central canal
- free fragments
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
AP Open Mouth: cervical
on image
- lateral masses of C1 = a
- C2 vertebral body = e
ABCDs of CT for C-spine: s = soft tissue
- Examine the ___ soft tissues on the sagittal format for presence of edema due to ___.
- pre-vertebral
- trauma
The value of CT for the spine is in the ___ of ___.
depiction of bone
Cervical Spine Sprains
- severity can range from minimal involvment to _____ to concurrent symptomology like compression fractures
- ____ sprain = traction injury to anterior tissues and compression of posterior
- ____ sprain = traction injury to posterior tissues and compression to anterior
- subluxation
- hyperextension
- hyperflexion
Which type of C-spine view assesses the following:
- segmental stability at EROM
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
Degenerative Disc Disease (DDD)
- ___ in Disc Height, associated with
- ____
- nuclear ____
- annular ____
Decrease in disc height
- dehydration
- nuclear herination
- annular protrusion
CPG: Canadian C-Spine Rules for Cervical Imagaing
Patients should have radiography if
- Dangerous ___
- >___ years old
- ____
- Midline _____
- unable to rotate ___
- Dangerous MOI
- >65 years old
- Paresthesias
- Midline tenderness
- Unable to rotate 45o
The value of MRI for the spine is in the depiction of ___, ___, and ____.
spinal cord, disc, and nerves
Which type of C-spine view assesses the following:
- ABC’s
- C3-C7
- C2-C3 IV disc space
- T1 ribs
- Spinous processes
- Pedicles equidistant
AP Lower C-spine
On image
- B = midline of spinous processes
- A = uncinate processes (pedicles equidistant)
Abnromal vertebral alignment and joint relationships could be impacted (but not limited to) sprains, ____, burst fractures, ____ injuries
Sprains, fractures, burst fractures, compression injuries
Degenerative Joint Disease (DJD)
- Osteoarthritic changes at the ____, which can impact multiple levels
facets
