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Differential Diagnosis > Radiological Eval of C-Spine > Flashcards

Radiological Eval of C-Spine Flashcards

1
Q

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
A

disease or infection

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2
Q

Trauma to the Cervical Spine: Stable or Unstable

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

Stable

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3
Q

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
A

C = canal space

  1. spinal canal
  2. thecal sac
  3. effacement
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4
Q

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.
A

alignment

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5
Q

Trauma to the Cervical Spine

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

CT

  • will screen more
  • relatively cheap, short, and greater access than MRI
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6
Q

Two types of fractures charateristic of the cervical spine:

  1. ___ = can see secondary to spinous ligament sprain
  2. ____ = wedge, impacted, or burst
A
  1. Avulsion
  2. Compression
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7
Q

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
A

Sagittal plane

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8
Q

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

A

Foramen and central canal

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9
Q

Trauma to the Cervical Spine: Stable or Unstable

  • fracture dislocations, facet dislocations
A

Unstable

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10
Q

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
A
  1. anterior vertebral bodies, posterior bodies, and spinolaminar conjuction
  2. Step-offs
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11
Q

DDD can lead to:

  1. vertebral endplate ____
  2. Increased ____ changes at joints
  3. Stenotic changes at ____ and ____
A
  1. approximation
  2. stenotic
  3. vertebrae and discs
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12
Q

In a coronal evaluation of the C-spine:

  • assess normal ____ relationship
A

craniovertebral

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13
Q

Trauma to the Cervical Spine: Stable or Unstable

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

Stable

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14
Q

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

A
  1. AP Open Mouth
  2. AP lower c-spine
  3. lateral
  4. Right Oblique
  5. Left Oblique
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15
Q

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
A
  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 ?
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16
Q

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
A

Axial Plane

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17
Q

Which type of C-spine view assesses the following:

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

Oblique View (Right and Left)

On image

  • A = foramina
18
Q

Degeneration of the Cervical Spine

  1. DDD = ___
  2. DJD =____
  3. ____ stenotic changes
  4. ___ ___ stenotic changes
A
  1. Degenerative Disc Disease
  2. Dengenerative Joint Disease
  3. Foraminal
  4. Central Canal
19
Q

ABCDs of MRI for C-spine

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

alignment

20
Q

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
A

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
21
Q

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

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

Lateral View

22
Q

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.
A
  1. Posterior and posterolateral
  2. Herniated Discs
23
Q

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
A
  1. edema
  2. spinal cord
24
Q

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

A

stenotic changes

25
Q

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

A

Hyperextension

26
Q

Trauma to the Cervical Spine: Stable or Unstable

  • immediate serious risk to spinal cord or nerve root => will need surgical intervention to repair
A

Unstable

27
Q

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
A
  1. destruction
  2. cortical margins
28
Q

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
A
  1. disc height, hydration of the nucleus pulposus
  2. posterior = sagittal, posterolateral = axial
29
Q

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
A

C= Canal Space

  1. spinal canal space
  2. central canal
  3. free fragments
30
Q

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
A

AP Open Mouth: cervical

on image

  • lateral masses of C1 = a
  • C2 vertebral body = e
31
Q

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

  • Examine the ___ soft tissues on the sagittal format for presence of edema due to ___.
A
  1. pre-vertebral
  2. trauma
32
Q

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

A

depiction of bone

33
Q

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
A
  1. subluxation
  2. hyperextension
  3. hyperflexion
34
Q

Which type of C-spine view assesses the following:

  • segmental stability at EROM
A

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
35
Q

Degenerative Disc Disease (DDD)

  • ___ in Disc Height, associated with
  1. ____
  2. nuclear ____
  3. annular ____
A

Decrease in disc height

  1. dehydration
  2. nuclear herination
  3. annular protrusion
36
Q

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 ___
A
  1. Dangerous MOI
  2. >65 years old
  3. Paresthesias
  4. Midline tenderness
  5. Unable to rotate 45o
37
Q

The value of MRI for the spine is in the depiction of ___, ___, and ____.

A

spinal cord, disc, and nerves

38
Q

Which type of C-spine view assesses the following:

  • ABC’s
  • C3-C7
  • C2-C3 IV disc space
  • T1 ribs
  • Spinous processes
  • Pedicles equidistant
A

AP Lower C-spine

On image

  • B = midline of spinous processes
  • A = uncinate processes (pedicles equidistant)
39
Q

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

A

Sprains, fractures, burst fractures, compression injuries

40
Q

Degenerative Joint Disease (DJD)

  • Osteoarthritic changes at the ____, which can impact multiple levels
A

facets

Differential Diagnosis (11 decks)

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