Flashcards in Cervical Spine Deck (125)
Standard projections of cervical spine:
When is swimmer's lateral projection performed?
necessary to assess lower cervical segments and cervicothoracic junction
What view should be ordered with trauma cases with suspicion of cervical spine fracture?
cross-table lateral, AP, and APOM views
When are bilateral oblique projections obtained?
when assessment of neural foramina necessary
What can flexion-extension lateral views asses?
Examination of pediatric patients at high risk for instability, should have what view?
active lateral flexion/extension view
CT for cervical spine is more sensitive detecting what?
subtle injuries and better at visualizing craniovertebral and CT junctions
When is MRI for cervical spine recommended?
recommended for any patient with neurological deficit for its ability to demonstrate position of bony fragments as well as injury to spinal cord, disk, and soft tissues
What are the evidence based guidelines to help determine if a patient needs radiographic examination?
Canadian C-Spine Rule (CCR)
National Exmergency X-Radiography Utilization Study (NEXUS)
Who does CCR apply to?
patient who are alert and medically stable
Tool designed to decide whether conventional radiography of c-spine necessary for patients who have sustained traumatic injury involving head o
What questions does the CCR ask?
1. Are there any high-risk factors that mandate radiography?
2. Are there any low-risk factors that allow safe assessment of ROM?
3. Is patient able to rotate neck actively at least 45° to right and left?
What are examples of high risk factors?
older than 65
parenthesis in extremities
What are examples of low risk factors that allow for assessment of ROM?
simple rear-end motor vehicle accident
normal sitting position
patient ambulatory at any time
delayed onset of neck pain
absence of mid-line cervical spine tenderness
What is CCR sensitivity and specificity?
What is NEXUS?
low-risk criteria developed to help identify patients following trauma who do not need diagnostic imaging for c-spine based on their clinical presentation
What are the guidelines for NEXUS:
No posterior midline cervical tenderness
No evidence of intoxication
Normal level of alertness and consciousness
No focal neurological deficit
No painful distracting injuries
What is NEXUS sensitivity and specificity?
What are the ACR recommendations if a patient meets CCR and NEXUS criteria?
CT with sagittal and coronal reformatting or both CT and MRI as complementary studies to assess instability or myelopathy
If patient has a history of trauma, what is viewed first?
lateral view if not being evaluated at trauma center wit advanced imaging
What do lateral views allow for?
assessment of normal cervical alignment with series of parallel vertebral lines
How is the cross-table lateral view performed?
in severe trauma cases, performed on supine, immobilized patient
preliminary diagnostic screen
What does the lateral flexion/extension view stress?
views performed to expose excessive segmental motion during functional movement
What do stress view give joint?
more opportunity to reveal instability by imposing mechanical stress
What does evaluation of radiographs for significant signs of cervical trauma include:
What are abnormal soft tissue signs?
1. widened retropharyngreal or retrotracheal spaces
2. displacement of trachea or larynx
3. displacement of prevertebral fat pad
What is the prevertebral tissue distance in adults?
6 at 2 and 22 at 6
What do abnormal vertebral alignment signs include?
1. loss of parallelism
2. loss of lordosis
3. acute kyphotic angulation with widened interspinous space
4 rotation of vertebral body
What does loss of parallelism indicate?
fracture, dislocation, or severe degenerative changes