CERVICAL SPINERTEC 124 WEEK 6Rev 2010

Review theanatomy

Direction of cervical zygapophyseal joints seen in LATERAL positionseen in OBLIQUE

INTERVERTEBRAL FOREAMENAP = SIDE UP PA = SIDE DOWN

POSITIONING FOR CERVICAL SPINEROUTINE 5 views (arthritis, etc)AP ODONTOID AP (axial) BOTH OBLIQUES, LATERAL (UPRIGHT)SWIMMERS LATERAL (if needed)

ROUTINE 2view AP (axial) , AP ODONTOID, LATERAL (UPRIGHT)SWIMMERS LATERAL (if needed)

TRAUMACROSS TABLE LATERAL (minimum) CLINICAL ROUTINE LATERAL (UPRIGHT) pt is C/R

PT is or AP ODONTOID

< C/R (15 20 ) (AP )AP (axial) BOTH OBLIQUES,

SWIMMERS LATERAL (if needed) pt is or

Done supine or upright

May be more difficult to do upright - use a sponge on back of head to relax neck musclesMay need to use a or C/R < 5 To move incisors off dens

Done supine or upright

LATERAL C.SP

Some rotation ((zygo & pillars not s/i)& TILT

C.SP OBLIQUES

With head in true lateral Look at the mandible position

With head in oblique Look at the mandible position

SWIMMERS FOR C.SPTWINNING &PAWLOW METHODS

Name of the position ?

C/R @ C7- T1PERP OR ANGLED 5 CAUD

Alternate Positioning

FLEXION &EXTENSIONPurpose?Flexion and extension views should be obtained in awake and cooperative patients to further evaluate for injury. Flexion views will exaggerate the radiographic abnormalities and extension views will reduce them. Anterior subluxation & check for ROM

Alternate Positioning

Fuchs vs Judd

Demonstrates?MML to IRMML // with CR

AP oblique atlanto-occipital joint.

BEST SEEN

SPINAL INJURY PTan overview :this will be covered in more detail in the TRAUMA lecture

TRAUMA SERIESSHOULD CONSIST OF 2 views /projections90 TO EACH OTHER

MOVE C/R AND CASSETTE NOT THE PATIENT !!!

TAKE IT AS IT LIES DO NOT HARM

When the patient is a true trauma care must be taken not to move the patientAt a minimum the APs & laterals are done with the C.COLLAR in placeThen after CLEARED by the MD you may proceed (?w/o? collar????? )May be required to repeat AP & Lat again without collar artifact

X-TABLE LATERALSAKA DORSAL DECUBITUSCERVICAL SPINECan be done with or without a gridWith Comp Rad probably need a grid

X-table Lateral C. SP

Peds pt with comp Dis loc C-2 C-3Pt died on table

For Odontoid in C collar

X-table lat Swimmers Note: Mrs. Charmans tip :Place forearm on forehead to prevent superimposition of humerus + c.sp

OBLIQUE TRAUMA C.SPAlternate Trauma Views

Pathology TermsHANGMANS FXJEFFERSON FXCLAY SHOVELERS FXSUBLUXATIONCOMPRESSION FX

REVIEW PG # 388 MerrillsNeck pain Many causes including Trauma MVA, sports, falls degenerative diseaseInfectionsNeoplasms congenital variations,inflammatory arthritispsychic tension

Etc

Whiplash Injuries

Passengers forewarned of an impending rear collision can potentially protect themselves by flexing the neck and tucking the chin against the chest. An extended head potentiates the risk of ligamentous rupture and articular dislocation. Areas of preexisting degenerative disease are most susceptible to injury.

radiculopathy- segmental motor or sensory signs associated with a root disorder. (numbness in hands/arms)Tear drop fxfrom Extreme flexion

more pathology C. SP

C-1 ring fxSpinal Cord

.AVULSION FX c-1A fracture involving the entire anterior arch is unstable

A wedge fracture of a vertebra is caused by compression between two other vertebrae Surgical repairAfter subluxation orWedge fx

HANGMANS FX C.SP

The hangmans fracture is located in the pedicles of C2, with C2 displacing anteriorly on C3

Jeffersons fxa burst fx of C-1 atlas = results from compression of the C.SP may also be associated with fx of C-2 (axis)May or may not involve the transverse ligament

Jefferson fracturelateral displacement of lateral masses of C1 bilaterally (white lines).

Image Critique (Elsevier)

Image Critique (Elsevier)There are two possible reasons: excessive rotation of the upper torso beyond a 45 oblique position or incorrect or inadequate CR angle angleShoulders are not rotated away from the cervicothoracic region, preventing clear image of the spine.

Excessive flexion excessive extension of neck

excessive extension of neckexcessive flexion of neck

Some rotation & Tilt

C 7 not seen

Use weights (5-10) lbs if possibleExpose on expiration

Not enough rotation to 45Position?TOO much rotation (look at spinousProcess)Looks like AP

Upper OK lower - too much rotation of body (Done PA ) CR < wrong way

LAOHead is lateral

Atlas & post arch obscuredCortex of skull on s/IMandibles not s/I

1st Tsp not shown(head tiled away from IR too much)

CR/IR too superior

Keep IP line to IR & move CR

Some studies of spinal trauma have recorded a missed injury rate as high as 33%.

C1 c2 sublux c4 wedge fx

Fracture of the pedicles with dislocation of C5 and C6. Note superior portion of C7 shown on this image.

Dislocation of the C3 and C4 articular processes Note that C7 is not well demonstrated