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zygopophyseal (facet) joint
- a synovial joint between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it
- sup facet is more medial than the inf
3 functions of zygapophyseal joints
- cary axial load of body
- limit ROM of spine
- form back border of intervertebral foramen (can cause LATERAL CANAL STENOSIS when hypertrophied from osteoarthritis)
zygapophyseal joints can cause what when hypertrophied from osteoarthritis?
lateral canal stenosis
raised lateral edges of vertebral bodies in the cerebral spine
holes in the TPs of the 7 cervical vert
column-like structures formed by the rticulation of the superior and inferior articular processes of the vertebrae.
3 details he emphasized about Atlas
- no body
- sup articular facets articulate w/ occipital condyles of skull
- head moves back/forward on this vert
which c-vert is most responsible ofr head moving foward and back? which for side to side?
- forward and back: atlas
- side to side: axis
- the SPs of C3-6
- axis too, according to the pics
what goes thru the transverse foramen?
- vertebral artery & vein
x-ray w injected contrast
standard views for c-spine x-rays
- ondontoid (open mouth)
- R and L oblique (to look at neural foramen, bc they're on anlges)
- Swimmer's (arms flexed, one ot 45, one to 135)
- Flex and Ext of neck
how many views to get of C-spine? when to get an x-ray of top of T1 too?
- 2 is min, but some institutions do 5
- if history of trauma, image to the top of T1
what's the dark tube going down the center of a c-spine x-ray?
- on a lat view it's ant to the spinal cord
lateral view x-ray, where do you find the dens?
it comes up from the ant portion of C2 and skewers C1
4 spinal lines
- anterior longitudinal line (ant of vert body)
- posterior long line (post of vert body)
- spinolaminar line (post wall of spinal canal)
- spinous process line (along post edges of SPs)
3 types of degen changes in bones on x-rays
- disc space narrowing
- sclerosis of end plates ( end plates are inflamed, an dthis leads to the ends of bones getting thicker, denser, whiter, more irregular)
signs of sclerosis on an x-ray
- increased density (more radiodensity inside the trabecular space)
- loss of trabecular pattern (the white of the rim goes within)
if disc space is narrowed it indicates what?
- narrowed: degenerative disease
- widened: trauma
when can you see ligaments in an x-ray?
only when they're abnormally calcified
3 symptoms of DDD
- loss of disc ht
- sclerosis of end plates
- hypertrophic changes (osteophytes)
if an x-ray shows DDD, what to ask next?
- are there neurological signs or symptoms?
- abnormal DTRs?
- motor > sensory changesbowel/bladder incont
- difficulty w walking (not pain related)
ACR's guide to what to order if there's neck pain
- chronic neck pain -- get an x-ray
- if no neuro signs/symptoms -- get nothing else
- if there are some -- get an MRI
Dennis clacification of stable vs unstable injuries by columns
- 1 column injury: stable
- 2 column injury: unstable (probably)
- 3 column injury: unstable
- (unstable doesn't necessarily mean surgery)
Dennis classification's 3 columns
- ant column: ALL, ant annulus, ant 2/3 of vert body
- middle column: post 1/3 of vert body, post annulus, post long lig
- post column: posterior elements of the vert (everything post the foramen)
5 points of the bottom line for ordering imaging for c-spine trauma
- assess severity of trauma (NEXUS or CCR)
- get CT for all significant trauma
- MRI may be helpful in some
- for kids, get plain x-rays unless knowon to have other spinal fx
- consider the possibility of associated vascular injury in the c-spine - CTA or MRA of neck vessels
3 types of desn fx, and which is unstable?
- 1 - a chip off the top
- 2 - the whole top detaches
- 3 - the top breaks, taking a lower portion with it
- 2 is the most unstable
what happens to the cord in a cervical burst fx?
retropulsion pushes on the cord, giving compression
- from hitting chin on dashboard, or from hanging
- fracture thru pedicles of C2,
- ant sublux of C2
clay shoveler's fx
- hyperflexion causes avulsion of portion of SP by interspinous lig
- (from excessiv forced flexion???)
jumped facets - mechanism & 3 types
- extreme hyperflexion and axial load injury --> facets lock in abnormal pos, it's unstable
- locked facets (the inf of the upper one is now ant of the sup lower, where it should be post)
- perched (it's delicately sitting on top)
- subluxated (post but high)
flexion teardrop injury - what's happening here?
- teardrop fx of inf ant vert body
- spinal cord compression bc the rest of the body moves post
- SP of that vert breaks
- one of the most unstable c-spine injuries
- all 3 columns are disrupted
- often cord injury or paralysis
extension teardrop injury - compare to severity of flexion teardrop, and when is it unstable?
- not as severe as the flexion teardrop
- it's stable in flexion and unstable only in hyperextension
this was the basics of the slides. Before the test you must review them again and familiarize yourself with the images.