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Radiological Evaluation of C-spine Flashcards

1
Q

3 main views for C-spine

A

AP
APOM
Lateral

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2
Q

Swimmer’s lateral projection performed to assess:

A

Lower cervical segments and CT junction

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3
Q

Most diagnostic view

A

lateral

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4
Q

Oblique view assesses:

A

Neural Foramina: indicates radiculopathy

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5
Q

Flexion/Extension stress views assess:

A

instability

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6
Q

Best modality for viewing C spine Trauma

A

CT scan

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7
Q

If neurological deficit is detected in C spine what modality should be used?

A

MRI: can view bony fragments as well as injury to spinal cord, disk, and soft tissue

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8
Q

Two evidence based guidelines established by clinicians to decide whether or not to use radiographs:

A
  1. Canadian C-Spine Rule

2. National Emergency X-Radiography Utilization Study(NEXUS)

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9
Q

Canadian C-Spine Rule requires the patient to be___ and ___

A

alert and medically stable

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10
Q

What are the 3 main questions of the C-spine rule?

A
  1. Any high risk factors that mandate radiography?
  2. Any low risk factors that allow safe assessment of ROM?
  3. Is pt. able to rotate neck actively at least 45 degrees L and R?
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11
Q

High risk factors that mandate radiography include?

A

Age over 65 years, dangerous MOI, parathesia in extremities

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12
Q

Low risk factors that mandate radiography include?

A

Tenderness over midline of Cspine, pain with normal sitting, DOMS of neck, pt not being ambulatory at time of crach

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13
Q

Canadian C-spine Rule has what sensitivity and specificity?

A

100% sensitivity and 43% specificity

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14
Q

For NEXUS, radiographs are indicated following trauma unless pt meets all five criteria:

A
  1. No post. midline cervical tenderness
  2. No evidence of intoxication
  3. Normal level or alertness and consciousness
  4. No focal neurological deficit
  5. No painful distracting injuries
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15
Q

Nexus has a specificity of __ and a sensitivity of __

A

12.9%, 99.6%

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16
Q

Evidence based guidelines point to patient having a radiograph if they meet the following criteria

A
  1. Dangerus MOI
  2. Over 65 years old
  3. Paresthesia
  4. Midline Tenderness over spine
  5. Unable to rotate neck 45 degrees L or R
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17
Q

ACR recommends that if pt meets criteria for CCR or NEXUS then this modality should be used with these 2 views

A

CT with sagittal and coronal reformatting

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18
Q

ACR recommends that if pt meets criteria for CCR or NEXUS then these two modalities should be used as complementary studies

A

CT and MRI

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19
Q

This view should be used first if the pt has had a history of trauma but has not be evaluated for trauma yet

A

Lateral: assess normal cervical alignment with series of parallel vertebral lines
-discontinuity or step offs indicate possible fracture/dislocation

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20
Q

This view is used in severe trauma cases and functions as a preliminary diagnostic screen

A

Cross-table lateral View

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21
Q

Radiology of C-spine evaluates:

A

soft tissue, vertebral alignment, joint characteristics

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22
Q

Widening retropharyngeal or retrotracheal spaces should follow these distance rules

A

6mm at 2 and 22mm at 6

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23
Q

Large IVD height indicates what kind of damage:

A

anterior tissue damage, rupture of posterior ligament

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24
Q

Small IVD height indicates what kind of problem:

A

IVD problem such as rupture of disk, extrusion of nuclear material

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25
Q

Loss of parallelism of Cspine indicates:

A

fracture, dislocation, or severe degenerative changes

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26
Q

Loss of lordosis of C-spine indicates:

A

muscle spasm in response to underlying injury

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27
Q

Acute Kyphotic angulation of the C spine indicates:

A

widened interpinous space indicating rupture of post. ligaments

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28
Q

Rotation of the vertebral bodies at the C-spine indicates:

A

unilateral facet dislocation, hyperextension fractures, muscle spasm, or disk capsular injury

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29
Q

APOM views what the best:

A

Lateral masses of C1 and the dens of C2

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30
Q

Normal overhang of the lateral masses of C1 over the body of C2 is:

A

1-2mm; any more is abnormal

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31
Q

A widened ADI indicates:

A

degeneration, stretching, or rupture of the transverse ligament

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32
Q

Widening of the interspinous process space indicates:

A
  • Fanning

- rupture of interspinous and other posterior ligamanets

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33
Q

Loss of facet joint articulation indicates:

A

dislocation

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34
Q

Injuries to the spinal cord are broadly classified as ___ and ___

A

stable and unstable

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35
Q

These injuries are protected from significant bone or joint displacement by intact posterior spinal ligaments: answer stable or unstable

A

Stable

ex//compression fractures, disk herniations, unilateral facet dislocations

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36
Q

These types of injuries show significant displacement initially or have potential to become displaced with movement: answer stable or unstable

A

Unstable

ex//bilateral facet dislocations, fracture-dislocations

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37
Q

What are the most frequently injured levels of the C-spine?

A

C1-C2 and C6-C7

38
Q

Adults mostly injure what levels of the C-spine

A

Lower levels

39
Q

Children more frequently injure what levels of the C spine?

A

Upper

They have big heads, upper spine can’t handle that much weight

40
Q

C-spine fracture has __% incidence of associated neurological injury

41
Q

C-spine is __ of all spinal cord injuries?

42
Q

What are the two most common MOI of the C-spine?

A
  1. Flexion/extension

2. Loaded flexion of C-spine

43
Q

SCIWORA Syndrome stands for:

A

Spinal Cord Injury Without Radiographic Abnormalities

44
Q

SCIWORA is predominant in what populations?

A

Children with inherent elastic pediatric spine

-cause ligamentous injury and cartilagenous vertebral endplate fracture

45
Q

In adults, SCIWORA presents as:

A

acute disk prolapse and/or excessive buckling of the ligamentum flavum

46
Q

Two main types of fractures of the C-spine include:

A

Avulsion and compression/impaction fracture

47
Q

Definition: bone fragment pulled off by violent muscle contraction or passive resistance of ligament applied against an oppositely directed force

A

Avulsion Fracture

48
Q

Definition: adjacent vertebrae forced together

A

Compression Fracture

49
Q

In a compression fracture: Axial compression produces __ fracture of impacted vertebral body

50
Q

In a compression fracture: flexion forces compresses impacted body into an anterior __ shape

51
Q

In a compression fracture: extension force compresses ___ __

A

articular pillars

52
Q

A wedge fracture is caused by a ___ force

A

hyperflexion

53
Q

This type of fracture occurs when the IVD is axially compressed and NP is driven through the adjacent vertebral endplate

A

Burst Fracture

-will see posterior displacement

54
Q

True or False:Burst fracture may be stable or unstable

A

True

Depends on configuration of fracture.

55
Q

Triangular fragment of bone becomes separated anterioinferior corner of vertebral body due to avulsion from hyperextension of compression from hyperflexion

A

Tear drop fracture

56
Q

What is the most severe lower cervical fractures?

A

Flexion teardrop

57
Q

Fracture from compressive hyperextension force combined with lateral flexion

A

Articular Pillar Fracture

-stable; normally at C6

58
Q

Avulsion fracture of SP by hyperflexion or forceful contraction of traps/rhomboids

A

Clay Shoveler’s fracture

59
Q

Uncommon fracture at TVP in C7; usually a result from lateral flexion forces causing an avulsion at tip of contralateral TVP

A

Transverse process fracture

60
Q

Most serious and life threatening injuries

A

Fractures associated with dislocations

61
Q

Transient dislocation or subluxations are often referred to as:

A

self-reducing dislocations

-momentarily disengage articulations but return to normal alignment once force dissipates

62
Q

Axial fractures associated with ant dislocation of C2 on C3

A

Hangmans fracture

63
Q

Complete facet joint dislocations unilaterally occur due to what type of force?

A

Hyperflexion and rotation force

64
Q

Complete facet joint dislocations occur bilaterally due to what type of force?

A

Hyperflexion Force

65
Q

What are the components of a unilateral facet dislocation tear?

A

One facet capsule and posterior ligaments

66
Q

If there is no vertebral body subluxation, is a unilateral facet dislocation stable or unstable?

A

Stable injury

67
Q

Are bilateral facet joint dislocations considered stable or unstable?

A

Unstable due to extensive disruption of post ligaments, facet joint capsules, annulus fibrosis and sometimes ant longitudinal ligament

68
Q

Which type of dislocation, unilateral or bilateral, would be most likely associated with spinal cord injuries?

69
Q

Hyperflexion sprains disrupt ant or post ligament complex?

A

Posterior; obtain stress views

70
Q

Hyperextension sprains disrupt ant or post ligament complex?

A

Anterior; may result in posterior subluxation

71
Q

What treatment would you do for sprains?

A

Immobilization, pain management, rehab

72
Q

What treatment options are there for dislocations?

A

Reduction(traction), Immobilization

73
Q

Acute disk herniation resulting in nerve root compression in Cspine is common or uncommon?

A

Uncommon: inherent anatomic protection within C spine formed by ant positioned NP, posteriorly reinforced AF, wide double layers of PLL and unconvertable joints

74
Q

Degenerative disk disease is due to the degeneration of:

75
Q

Degenerative joint disease is due to:

A

Osteoarthritic changes at synovial facet joints

76
Q

Foraminal encroachment is due to:

A

diminished dimensions of IVF secondary to degenerative changes in adjacent structures

77
Q

Spondylosis is due to:

A

osteophyte formation at joint margins

78
Q

Advanced spur formation from degeneration of vertebral bodies and AF contributes to:

A

Spondylosis Deformans

79
Q

Ossification along ant vertebral bodies and disk spaces contributes to

A

Diffuse idiopathic skeletal hyperostosis(DISH)

80
Q

What age group is at risk for Degenerative disk diseases

A

> 60 years of age

81
Q

Intervertebral herniation of NP through endplate into spongiosa of vertebral body is called

A

Schmorl’s nodes

82
Q

Nitrogen gas from extracellular spaces accumulating in degenerative dehydrated fissures of disk is called:

A

Vacuum Phenomenon

83
Q

Hallmark of DDD is:

A

decreased disk height

84
Q

Hallmark of DJD is:

A

decreased joint space, subchondral sclerosis, ostephytes

85
Q

What view would be used to see foraminal encroachment?

86
Q

What levels of the C-spine would you most likely find osteophytes in response to DDD

A

C4-C5 and C5-C6

87
Q

Would spondylosis deformans typically show a decrease in disk height?

88
Q

This type of degenerative disease typically shows a claw-like formation, cupping toward the IVD

A

Spondylosis deformans

89
Q

This type of degenerative disease has an unknown etiology but is often found in diabetic pt.

A

DISH(Diffuse idiopathic skeletal hyperostosis)

-also found in pt with growth hormones, vitamin A, retinoid derivatives, metabolic syndromes

90
Q

In what age and gender demographic group would you typically see DISH

A

Age 40, male

91
Q

3 criteria of DISH:

A
  1. Flowing ossification of at least 4 contiguous vertebral bodies
  2. Preservation of disk height
  3. Absence of facet joint DJD

Human Imaging (3 decks)

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