Lect. 4 Cervical Spine

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Lect. 4 Cervical Spine
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2012-05-03 11:34:33
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Lect Cervical Spine
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Lect. 4 Cervical Spine
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  1. Cervical Spine:
    -__ vertebrae
    - C_ (____): supports head, arches from bony ring
    -C_(____): Dens; privot point on which head rotates
    -C_-C_: share similar osseous features
    • -7
    • -C1 (atlas)
    • -C2 (axis)
    • -C3-C7
  2. T or F: ligaments show up on radiographs
    F: can be directly assessed on X-rays/indirectly assessed by looking at relationship of joints (i.e. loss of normal articular relationship implies loss of ligament support.)
  3. ___ has been found to be more specific than plain radiographs at detecting subtle injuries.
    ___ recommended if neurological deficit is present. Can demonstrate "position of bony fragment...injury to spinal cord, disk, and soft tissue in same exam.
    ____ not indicated in patients with significant injury and other imaging is available (fracture, dislocation, instability)
    • -CT
    • -MRI
    • -Radiographs
  4. _______ __-Spine Rules:
    -applies to patients who are alert and stable
    -designed t ohelp clinicians determine if radiographs are necessary for patients who have sustained traumatic injury to head or neck.
    -Meant to identify "clinically important cervical spine injry, defined as fracture, dislocation, or ligamentous instability demonstraded by diagnostic imaging.
    Canadian C-spine rules
  5. CCR
    1. Are there high risk factors
    -age greater than ____ or
    -paresthesias in extremities or
    -dangerous mechanism of injury
    -fall from >_m or __stairs
    -MVA at speeds >__mph or involving rollover/ejection
    -bicycle collision
    -motorized recreational acccident
    __ or more high risk factors present= radiographs required
    • -greater than 65
    • -fall from >1m or 5 stairs
    • -MVA at speeds >60
    • 1 or more high risk factors present=radiographs required
  6. CCR
    2. Are ther any low risk factors that permit safe AROM?
    -Able to assume sitting position in ER or
    -ambulatory at any time or
    -onset of neck pain not immediate or
    -absence of tenderness in C-spine or
    -MVA that does not include any of the following
    -pushed into oncoming traffic
    -hit by bus or large truck
    -rollover
    -hit by high speed vehicle
    Cannot Assess ROM= _______ required
    Cannot assess ROM= radiographs required
  7. CCR
    3. Can the patient actively rotate the neck __ degrees in both directions?
    If yes= no radiographs required
    If no= radiographs required
    45 degrees
  8. Nexus Low Risk Criteria: developed to identify patients who do not need diagnostic imaging for C-spine. Imaging is required unless patient meets all 5 of the following criteria.
    1. No posterior midline _______ tenderness
    2. No evidence of ______>
    3. Normal level of alertness and ______.
    4. No focal _______ deficit.
    5. No painful ______ injuries.
    • 1. NO posterior midline cervical tenderness
    • 2. No evidence of intoxication
    • 3. Normal level of alertness and consciousness
    • 4. No focal neurological deficits
    • 5. No painful distracting injuries
  9. Routine Radiological Eval of C-spine
    Standard views:
    ____ view: 5 lower cervical vert, upper thoracic vert and associated ribs, medial 3rd of clavicles, and trachea.


    •______ views –7 cerv vert, intervertebral disk spaces, articular pillars, facet joints, spinous processes, and paravertebral soft tissues.
    • 1. A-P view
    • 2. lateral view
  10. Special views
    •A-P ____ ____ – C1 and C2, dens
    •A-P or P-A ______ views –IV foramina, uncovertebral joints, facet joints, and pedicles
    •Lateral flexion and extension stress views—look for ______ ______.
    •_______ Lateral –Reveals C7, T1, T2
    • -open mouth- C1 C2 and dens
    • -oblique: IV foramina, uncovertebral joints, facet joints, and pedicles
    • -latera flexion and extension look for joint instabilities
    • -Swimmer's lateral reveals C7, T1, T2
    • 1. anterior vertebral line
    • 2. Posterior vertebral line
    • 3. spino-laminar line
    • 4. posterior spinous line
  11. Radiological Signs of Cervical Trauma (3 total)
    1. Abnormal _____ ____: widened retropharyngeal or retrotracheal space; displacement of paravertebral fat pad; tracheal or laryngeal displacement *** sugges presence of ___ or ____.
    2. Abnormal _____ alignment: loss of parallel outline on lateral view; loss of lordosis; acute kyphotic angulation c widened interspinous space; rotation of vertebral body.
    3. Abnormal _____ relationships: widened atlantodental space (damage to _____ ligament); widened interspinous space; widened IV disk space; narrowed IV disk space; loss of facet jt. articulation.
    • 1. Abnorma Soft Tissue: suggests presence of hemorrhage or edema
    • 2. Abnormal Vertebral alignment
    • 3. Abnormal joint relationships: damage to transverse ligament
  12. Upper Cervical Fractures:
    C1: ______ fracture: fracture of anterior and posterior arch of C1, results of compression force such as diving head first in shallow water.
    C2: _____ fracture: 3 types, classified as stable or unstable
    C2: _____ fracture: fracture of pedicles of the axis, can cause dislocatoin of C2 on C3. Hyperextension injury
    • C1: Jefferson's Fracture
    • C2: Odontoid Fracture
    • C2: Hangman's Fracture
  13. Odontoid Fractures :3 types
    Type __: upper dens: oblique (8%)
    Type__: base of dens; transverse (59%)
    Type __: body of axis, facets (33%)
    • Type I: upper dens/oblique
    • TypeII: base of dens/transverse
    • Type III: body of axis/facets
  14. Conditions with Atlanto-Axial Issues: there are 6 (4 are reasonable and the last two are dumb)
    • Down syndrome
    • Rheumatoid arthritis
    • ankylosing spondylitis
    • marfan syndrome
    • post trauma
    • post surgical intervention/failure
  15. _____ ____ ____: common in most people over 60; breakdown of intervertebral disk; imaging shows hallmark sign of decreased disk space, may have Schmorll's nodes, osteophytes at uncovertebral joints and vertebral endplates, and vacuum deformity.
    Degenerative Disk Disease (DDD)
  16. ______ ______ disease: OA changes to facet joints; imaging hallmarks include decreased joint space, subchondral sclerosis and osteophytes
    Degenerative joint disease
  17. ______ Encroachment: narrowing of intervertebral foramen as a result of degenerative changes of surrounding structures (DDD and/or DJD); nerve root can become compressed.
    Foraminal Encroachment
  18. ______ ______: formation of osteophytes in response to DDD; predominate location of osteophytes at areas with greater segmental mobility (C4-5, C5-6)
    Cervical Spondylosis
  19. ________ of C-spine: used for cervical trauma; shows bony injury, degree of displacement, soft tissue and spinal cord injury; most common Sagittal SE T1 and T2
    MRI of C-spine
  20. Thoracic Spine: Acute LBP clincial findings
    -presence of ___ ___.
    -No response to __ weeks of PT intervention.
    in the presence of these radiographs are indicated
    • -presence of red flags
    • -no response to 3 weeks of PT intervention
  21. T-spine views:
    ___: shows all 12 vertebrae, vertebral end plates, pedicles, IV disk spaces.
    ___: reveals all but upper 2 or 3 vertebrae, vertebral bodies, and IV disk spaces
    _____ ____: (position shoulder overhead): may be done to reveal upper thoracic vertebrae.
    • -A/P
    • -Lateral
    • -Swimmer's shoulder
  22. ______ vertebral body compression fractures: most common spinal injury detected on radiographs; comprise majority of vertebral fractures in thos over 60; pre-existing osteoporosis is a contributing factor; _____ forces causes 90% of this type of fx, and remaining 10% from fall or MVA.
    Anterior vert body compression fx's

    Flexion
  23. _______ disease: common in adolescent boys and girls; symptoms of backache and thoracic kyphosis from osteochondrosis; schmorl's nodes are consistent finding.
    Scheuermann's disease
  24. Lumbar Spine Views:
    __: shows all 5 vertebral bodies
    ___: shows alignment of lumbar vert and IV disk spaces
    __ and __ ____: show facet articulations, pedicles, pars (___ __ fx's). These have high levels of gonadal radiation!
    • A/P
    • Lateral
    • A/P and P/A oblique (scotty dog fx)
  25. Scotty Dog Fx: in an oblique view of a normal lumbar spine, the outline of a scotty dog can be seen.
    -the _____ process is the nose
    -the ______ is the eye
    -the ___ ______ is the neck
    - the _____ articular facet is the ear.
    - the _____ articualr facet is the front leg.
    • -transverse process is the nose
    • -pedicle is the eye
    • -pars interarticularis is the neck
    • -superior articular face is the ear
    • -inferior articular facet is the front leg
  26. Degenerative Conditions of Lumbar Spine:
    ______: formation of osteophytes in response to DDD.
    ______: defect in pars interarticularis (scotty dog fx)
    ______: forward displacement of vertebra. Can result from degenerative changes and/or fracture.
    _____ ____: central, intervertebral foramen, lateral or sub-articular recesses.
    • -spondylosis: formation of osteophytes in response to DDD
    • -Spondylysis: defect in pars interarticularis
    • -spondylolisthesis: forward displacement of vertebra
    • -spinal stenosis
  27. IVT ____ ____: protrusion of disk material through annulus; conventional radiographs poor at showing disk material but will show chronic changes to bone such as jt space changes, spondylosis, osteophytes vaccum sign and Schmorl's nodes.
    ___ myelography excellent for showing anatomic detail and ____ excellent at showing morphological and physiochemical changes of disk.
    • IVT disk herniation
    • CT myelography
    • MRI

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