Cervical Spine - Logan Class of December 2011

Report
Cervical Spine
Presented by M.A. Kaeser, DC
Spring 2009
Radiographic Anatomy
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APOM
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Dens
C1 Lateral masses
C1 Posterior arch
C1 Anterior arch
C1 TPs
Atlanto-occipital joint
Mastoid air cells
C2 spinous process
C2 transverse foramen
Mandible
Radiographic Anatomy
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Lateral view
C1 posterior tubercle
C1 posterior arch
C1 lateral mass
Dens
C2-C7 bodies
IVDs
Articular pillars
Facets
Laminae
SPs
Spinolaminar line
TPs
Soft tissue space (PLT)
Thyroid cartilage and larynx
Hyoid bone
Angle of mandible
Mastoid air cells
Radiographic Anatomy
http://files.abstractsonline.com/CTRL/12/6/B55/E60/AEE/
48C/3B7/51F/1B1/ADD/157/40/a1198_19.JPG
http://www.drkassicieh.com/images/MRI-Cervical-spine.jpg
http://www.jbppni.com/content/figures/1749-7221-2-17-1-l.jpg
Level of C5/6 Disc
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1 = SCM
2 = CCA
3 = Thyroid cartilage
4 = Laryngopharynx
5 = Piriform recess
6 = Trapezius
7 = SP
8 = TP
9 = C5/6 disc
10 = Vertebral a.
Level of C4
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1 = vertebral artery
2 = mandible
3 = hyoid bone
4 = laryngeal space
5 = ICA
6 = IJV
7 = body C4
8 = Spine
9 = Lamina
10 = SCM
Radiographic Anatomy
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APLC
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SPs
Laminae
Pedicles
TPs
Articular pillar
Uncovertebral joints
Costotransverse joint
Trachea
IVFs
Lung apices
http://www.e-radiography.net/technique/spine/spine-
Specific Problems
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Dislocations
• Atlantooccipital dislocation (unstable)
• Facet joint dislocation (unstable)
Atlantooccipital Dislocation
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Caused by complex injury
Usually causes death
Causes an increase in
prevertebral soft tissue width
Facet Joint Dislocation
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Three types
• Subluxed facets, perched facets, locked facets
Best seen on lateral view
Step deformity, >3 mm
Occur secondary to hyperflexion
Disruption of ALL, IVD and
posterior ligaments
http://sfghed.ucsf.edu/Education/ClinicImages/Jump%20facet
%20MRI.jpg
Fractures
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Unstable
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Flexion Teardrop
Hangman’s
Hyperextension fracture dislocation
Burst
Jefferson’s
Odontoid
Stable
• Clay Shoveler’s
• Wedge
• Extension Teardrop
Unstable Fracture
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Flexion Teardrop
• Extremely unstable
• Posterior displacement
of the vertebral body
Disruption of all ligaments
and IVD
Often results in anterior
spinal cord compression
http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg8.jpg
http://aser.mypacs.net/aser/repos/aser_repo/viz/full/0/0/2/2137.jpg
Unstable Fracture
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Hangman’s
• Bilateral C2 pedicle fracture
• MVAs or hangings
• Anterior displacement
of the anterior part of C2
http://www.spineuniverse.com/displaygraphic.php/4095/shaffrey_
16yocervicaltrauma_fig3b-99.jpg
Unstable Fracture
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Hyperextension fracture dislocation
http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg15.jpg
http://www.radiologyassistant.nl/images/4912b9174ba3fextension-4.jpg
Unstable Fracture
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Burst Fracture
• Axial injury
• Loss of anterior
and posterior body
height
Bony fragments may
push on the spinal
Cord
M/C in mid C/S
http://ajs.sagepub.com/content/32/4/1077/F5/graphic-9.large.jpg
http://www.radiologyassistant.nl/images/thmb_
49044098aa1abAfbeelding-9.jpg
Unstable Fracture
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Jefferson’s
• At least two
fractures of C1
• Secondary to an
axial injury
• Diving
• Heavy object
http://radiographics.rsnajnls.org/content/vol20/issue3/images/
http://img.medscape.com/pi/emed/ckb/orthopedic_
surgery/1230552-1264627-384.jpg
Unstable Fracture
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Odontoid Fractures
• Type 1
• Type 2 – most unstable
• Type 3
http://www.nypemergency.org/moxiepix/b2_3.gif
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Type I
http://download.imaging.consult.com/ic/images/
S1933033208734189/gr12a-midi.jpg
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Type II
http://www.radiologyassistant.nl/images/4911d5fd8c73bdens1.jpg
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Type III
http://www.radiologyassistant.nl/images/4911d96ff25dbdens5.jpg
Stable Fracture
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Clay Shoveler’s
• Secondary to a flexion injury
• Avulsion of a piece of SP
• M/C in lower C/S
http://www.mypacs.net/repos/mpv3_repo/viz/full/57139/2856961.jpg
Stable Fracture
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Wedge
• Flexion injury
• Compression of
anterior portion
of vertebral body
http://faculty.washington.edu
/alexbert/MEDEX/Winter/ch264fg6.jpg
Stable Fracture
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Extension Teardrop
• Avulsion of a piece of the
anteroinferior portion
of a vertebra
• Often occurs at C2
http://www.learningradiology.com/
caseofweek/caseoftheweekpix2008/
cow302lg.jpg
http://download.imaging.consult.com/ic/images/
S1933033207723352/gr1-midi.jpg

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