spine and skull Flashcards
1st rib
ankylosing spondytis
ankylosing spondytis
ankylosing spondytis
ankylosing spondytis
anterior arch of the atlas
atlanto-occipital dislocation
atlanto-occipital joint
atlas
axis
body of cervical vertebra
body of th axis
burst fracture
burst fracture
burst fracture
C7
cervical facets
A) vocal cord
B) intervertebral space
C) trachea
D) transverse process
E) spinous process
F) pedicle
cervical transverse processes
chance fracture
clay shovelers
compression fracture
compression fracture
compression fracture
dens
first rib
hangmans fracture
hangmans fracture
heart shadow
jefferson fracture
jefferson fracture
red: clay shovelers
blue: burst fracture with associated swelling
red: lipping
blue: calcification
green: spondlylolithesis
spondylolisthesis C4-5
lipping C5-6
abnormal lines in the cervical vertebral body and lamina
body, lamina, spinous process lines
latearl cervical MRI
soft tissue edema
A) atlanto-occipital joint
B) dens
C) posterior arch of the atlas
D) inferior facet of C2
E) transverse process
F) superior facet of C3
G) lamina of C5
H) intervertebral disc space
I) pedicle
J) spinous process of C6
K) C7
A) C1
B) body of the axis
C) posterior arch of the atlas
D) spinous process
E) transverse process
F) C7
lateral lumbar
thoracic body
thoracic pedicle
transverse process
spinous process
lumbar oblique
Left: thoracic scoliosis
right: lumbar scoliosis
pedicle
S1
spinous process
transverse process
lumbar body
lumbar burst fracture
CT
CT
lamina
body
pedicle
spinous process
metastatic disease
metastatic disease
metastatic disease
metastatic disease
metastatic disease
oblique C Spine
A) pedicles
B) intervertebral foramen
C) superior articulating facets
D) spinous processes
E) inferior articulating facets
F) 1st rib
odontoid fracture
open mouth CT
A) odontoid process
B) inferior facet of C1
C) atlanto-axial joint
D) superior facet of C2
E) spinous process
pagets disease
posterior arch of the atlas
scheurmans kyphosis
scottie dog
spondylolisthesis
spondylosis
swimmers
swimmers
C7
pedicle
thoracic scoliosis
C7 to T12
spinous process
transverse process
what views are used in the cervical spine
- AP
- lateral
- swimmers
- oblique
- flexion
- extension
what three views are used in cervical trauma
- AP
- cross table lateral
- odontoid
how should vertebrae look on x ray
stacked marshmellows
what three alignments should be checked on an AP or lateral
- body alignment
- lamina alignment
- spinous process alignment
how should the lateral edges of the spine look on edge
smooth rolling lines
what are seven features to look for on a cervical xray
- size and symmetry of bodies
- normal alignments x3
- smooth lateral edges
- no fractures
- normal axis and atlas
- no large soft tissue mass
- normal disc spaces
what three vertebrae must be included on a cervical X ray
C1, C7, T1
soft tissue at C2 should be no thicker than _____
soft tissue at C6 should no thicker than _____
6mm
2cm
when should a swimmers view be done
when the shoulder doesn;t allow a clear picture of C7-T1
when would someone do a cervical oblique
when there is a suspected facet issue
when would someone use an open mouth view
to see the dens
what are some issues to look for in an open mouth xray
is the dens a normal size
are there equal and normal spaces around the dens
what are two reasons someone might do a lateral flexion/extension view
- checking for rheumatological disease
- checking to see if the patient can be intubated
what two view are normally done in the thoracic spine
AP and lateral
when examining a thoracic x ray what are five issue to look for
- step deformity
- midline spinous processes
- spinous processes eqidistant from both pedicles
- evenly space sternoclavicular joints
- equal disc spaces
what structures should be included in a thoracic xray
C7-L1, all transverse process, at least part of all the ribs
what is a lateral thoracic useful for
looking for scoliosis and compression fractures
what five views are used in the lumbar spine
- AP
- lateral
- oblique
- flexion
- extension
what structures should be included in a lumbar xray
L1-S1
what is the oblique lumbar view used for
to look for spondylolysis
par interarticularis
the portion of the lamina between the superior and inferior articular processes
what is CT used for in the spine
- look for bony abnormalities
- rule out C spine fracture
- when MRI is not an option
what is MRI useful for in the spine
- look for soft tissue deformity
- no radiation
T/F contrast should be used on an MRI if the patient has undergone surgery or there is a history of cancer/chemotherapy
true
what are some metallic implants that would not permit MRI
- aneurysm clips
- pace makers
- ocular foreign bodies
- metal cardiac valves
what are seven unstable cervical spine fractures
- atlanto-occipital dislocation
- facet joint dislocation
- hangmans
- hyperextension fracture
- burst
- jeffersons
- odontoid
what are the stable fractures of the cervical spine
- clay shovelers
- wedge
what are the unstable fractures of the lumbar and thoracic spine
- chance fracture
- burst fracture
what are the stable fractures of the lumbar and thoracic spine
- wdge
- spinous process fracture
- spondylolysis
- spondylolisthesis
three types of facet joint dislocation
- subluxed
- perched
- locked
what is the difference between subluxed, perched, locked facets
subluxed is just some slippage
perched means complete subluxation but not jumped
locked means the superior facet has slid anterior over the inferior facet
what happens in a hangmans fracture
there is bilateral pedicle fracture at C2 which pushes C2 anteriorly
what will a hangmans fracture feel like on palpation
a step off at C1-2
what happens in a jeffersons fracture
the atlas “smooshes” due to an axial force applied to the top of the head
what will a jefferson fracture look like on imaging
a C1 with splayed out lateral masses and too much space around the odontoid
what are the three grades of an odontoid fracture
- just the tip
- through the odontoid
- fracture through the base of the odontoid into the body of C2
what kind of odontoid fracture is most unstable
grade two
what is a clay shovelers fracture? how is it caused
a spinous process fracture at C6 or 7
commonly found secondary to a flexion injury
what is the key indication of a burst fracture
parts of the body will be pushed back
T/F an xray is all that is needed to assess burst fracture
false, if a burst fracture is suspected a CT should be done
what two fractures are common with a patient who jumped from a height and landed on their feet
lumbar burst fracture and calcaneus fracture
how can a compression fracture be differentiated from a burst fracture
they are less traumatic and the defect doesnt push the body back
what are four possible conditions that wold lead to a compression fracture
- osteoporosis
- osteomalacia
- pagets disease
- multiple myeloma
osteomalacia
inadequate phosphorus, calcium, and vitamin D in blood that leads to softening of bone
pagets disease
a nonmetabolic bone disease that is characterized by excessive bone destruction and repair
what will pagets disease look like on xray
vertebrae with white streaks of hypertrophied bone next to areas of decreased bone density
multiple myeloma
malignant neoplasm of the bone marrow, usually looks like a punched out lesion in bone
T/F multiple myeloma often present with compression fracture
true
chance fracture
a fracture through the spinous process into the vertebrae
how do chance fractures hapen
hyperflexion with the leg immobilzed (child with a lap belt)
how will a chance fracture look on a lumbar AP
a missing spinous process
spondylolysis
a defect in the pars interarticularis that can cause sponylolisthesis
spondylolisthesis
a movement of one vertebrae in relation to the inferior vertebrae common in L5-S1
what sign is indicative of spondylolysis
a “scottie dog” with a collar or broken neck
how many grades of spondylolisthesis are there? what are they indicative of
4
- grade 1: 1/4 slippage
- grade 2: 1/2
- grade 3: 3/4
- grade 4: completely slipped off
sclerotic change to a disc
hardening and osteophyte formation
how will a calcified disc look on xray
hazy white instead of dark gray
lipping
osteophyte formation that forms a narrow disc space with lips
ankylosing spondylytis
a chronic inflammatory condition that results in the vertebrae growing together around disc spaces
what is the difference between ankylosing spondylitis on xray
lipping is osteophyte formation, AS will cause syndesmophyte formation with smooth edges
what sign is indicative of ankylosing spondylitis on xray
bamboo spine, squared vertbrea with smoothed disc spaces
scheurmans kyphosis
anterior wedging of the thoracic vertbrae, common in adolescent boys
what is the diagnostic criteria for scheurmans kyphosis
3 consecutive vertbrae with +5deg of wedging
what is the main factors determining what type of treatment is best for scheurmans kyphosis
how much time there is availible for bracing based on the patients age
how will metastatic disease present itself on xray
can be moth eaten or ivory vertbrae
what types of cancer metastases are common with ivory vertbrae
prostate and breast cancer
what types of metastases present with a moth eaten or punched out vertebrae
breast, multiple myeloma
- what is this?
- what is it indicative of?
- what view is this in?
- air fluid interface in the left maxillary sinus
- fluid or tumor in the right sinus
- waters
- what is this?
- what is happening?
- basilar skull fracture with hemotympanum
- blood from the skull fracture is collecting behind the ear
basilar skull fracture
what is this? what might cause this
battle sign
basilar skull fracture
- what is this?
- what might cause this?
- what bones are fractured to cause this
- a blowout fracture
- a blow to the orbit
- the zygomatic/maxillary bone
- what is this
- name a two likely causes
- a blowout fracture
- a racquet ball to the face, MVA
what would make this happen?
a blowout fracture that traps the inferior rectus so it can’t contract to move the eye up
what is happening here? how can you tell?
bony destruction caused by infection or neoplasm
because the septum and nasal concha are gone
what view is this
caldwell/AP
coronal suture
coronoid process
crista galli
what is this? what complications come from this?
depressed skull fracture
increased intracranial pressure and hemorrhage
what is this? how can you tell
epidural hematoma, because it is more lens shaped than flat
epidural hematoma
ethmoid
- what are the arrow indicating?
- why would this be abnormal?
- what is causing this?
- falx cerebri
- they are deviating to the left
- increased intracranial pressure
floor of the sella turcica
frontal sinus
greater wing of the sphenoid
what is this?
what would cause this?
hemotympanum
basilar skull fracture
inferior nasal concha
inferior nasal concha
lacrimal bone
lambdoidal suture
maxilary sinus
frontal sinus
right and left ventral horns
linear skull fracture
mandibular condyle
maxillary sinus
- what are these?
- what do they represent?
- what is a common cause?
- oil droplets
- areas of bone destruction
- multiple myeloma
optic sulcus
orbital roof
what view is this
panorex
what is this called? what might you suspect if you see this?
raccoons sign
basillar skull fracture
ramus of the mandible
sinusitis
scalp hematoma
sinusitis
sphenoid sinus
sphenoid sinus
what is this?
what is happening?
subdural hematoma
blood is collecting in the subdural space
what view is this? what is it used for?
townes
looking at the back of the skull
what view is this? what is it used for
waters
getting better look at the frontal and maxillary sinuses and the orbital floor
zygomatic bone
what are the maxillary sinuses hard to evaluated on an AP/caldwell?
because the beam has to pass through the skull and brain
what is a lateral skull xray best for?
looking for fracture lines
when taking a townes view, how is the head positioned
the head stay neutral but the beam is directed at an angle
how are the teeth numbered in a panorex view
top row, left to right, 1-16
bottom row, right to left, 16-32
what is the most common skull fracture? is it considered serious
linear
no, other than there may be a bleed associated with it
why are depressed skull fractures serious?
they are more likely to involved injury to the brain
what is the most serious type of skull fracture
basillar
what physical exam findings might indicate a basilar skull fracture
- CSF leak from the nose or ears
- hemotympanum
- raccoon sign
- battle sign
what should be in the maxillary sinus?
if there is an interface, what might you suspect is the cause
mostly air, no fluid interface
blood in the sinus, sinusitis, or tumor
what is the primary indication of sinusitis
thickened nasal concha
what are two possible causes of bony destruction of the septum or sinuses?
- funal infection
- cancer
how can you typically tell the difference between a epidural and subdural hematoma
epidurals are more of a lens shape
subdural is more of a crescent shape
what percent of epidural hematomas are associated with skull fractures? where are they most common?
95%
unilateral temporoparietal region
