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Semester 3 PM Exam 2 > Diagnostic Imaging - Cervical Spine > Flashcards

Diagnostic Imaging - Cervical Spine Flashcards

(70 cards)

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1
Q

Standard views for initial visit w/o trauma

A

Ap and lateral

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2
Q

Standard if trauma is involved

A

Open mouth
Oblique (l and r)
Swimmers

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3
Q

Position of patient

A

Done with patient in upright position - shows effect of gravity on the spine but some circumstances this may be dangerous

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4
Q

Ap projection patient position

A

Standing but is most typically done in supine

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5
Q

AP projection - central ray is projected

A

in upward direction about 20 degrees just below the thyroid cartilage

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6
Q

AP projection - thyroid will be

A

black - filled with air

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7
Q

AP projection - clavicles

A

Distorted - tend to be magnified due to distance away from film - appear large and wide

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8
Q

Lateral projection - what do you see

A 
All 7 vertebrae
SP C2-C7
Post arch C1
Intervertebral space 
Facet joints
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9
Q

Lateral projection provides a great deal of info regarding

A

alignment and stability of the spine

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10
Q

Lateral projection - no trauma patient postion

A

erect

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11
Q

Lateral projection - trauma - patient position

A

Supine

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12
Q

What is easy to mistake with lateral projection

A

Post arch of C1 for a SP

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13
Q

Lateral projection alignment

A

3 lines that run parallel
Line 1 = ant aspect of bodies
Line 2 = post bodies
Line 3 = Spinolaminar

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14
Q

Lateral projection - ABCs - you should be seeing

A

C1-T1 and if you can’t see T1 then another projection has to be taken

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15
Q

Predental space

A

Distance btw dens and atlas
Adult - 3mm
Chld - no more than 5mm

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16
Q

Open mouth view is

A

an AP that is focused on the AA joint - indicated when the patient presents with a trauma or signs of instability

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17
Q

Open mouth image should include

A

Dens, lateral masses of C1 and C2

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18
Q

Swimmers view is geared towards evaluation of

A

C7 T1 interface

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19
Q

Swimmers view - patient position

A

arm fully abducted - typically the one closes to the receptor
Reverse swimmers view if abduct the other arm
Prone position

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20
Q

Central ray - swimemrs view

A

Central ray laterally through the axilla toward opposite coracoid process

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21
Q

Right and left oblique - what should you see

A

Vertebral bodies and SP
Pedicles
Facet joints
Intervertebral foramina

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22
Q

Oblique projections may be done in situations in which

A

lateral spinal nerve root compression is suspected

Projection is 45 degrees away from the lateral

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23
Q

Oblique projections - central ray

A

is directed at C4 at a 15-20 degree upward angle

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24
Q

Oblique allows for best visualization of

A

Intervertebral foramina

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25
Right oblique will visualize
the right intervertebral foramina
26
DDD - what is it
Degenerative disc disease Begins with changes to IVD trauma or aging process
27
DDD - radiographic features of DDD include
1. Dec in IVD space 2. Osteophytes 3. Schmorts nodes (lumbar) 4. vauum phenomenon
28
DJD - initial fidnings
degeneration of the facet joints | Thinning of articular cartialge and bone sclerosis
29
Radiographic findings for DJD
1. Dec joint space (cuz of facets) 2. Osteophytes 3. Subchondral sclerosis
30
Spondylosis
degenerative processes
31
Segments that are most susceptible to injury
C1-C2 and C6-C7
32
Hyperflexion injuries
``` Forcing the cervical spine past its available end range of flexion Hyperflexion sprain Wedge fracture Flexion teardrop Avulsion fracture Bilateral facet joint dislocation ```
33
Hyperflexion sprain
AKA anterior subluxation Occurs when post ligaments rupture Considered to be stable because ant and midd columns stay n tact
34
Radiographic features - hyperflexion sprain
Loss of normal curvature Ant displacement of vertebral body Inc interspinous distance
35
Wedge fracture
Greater than 3mm height diff btw the ant and post aspect of the vertebrae indicates fracture Considered stable if post ligaments remain intact and unstable if not
36
Radiographic features - wedge fracture
Dec ant vertebral body height Inc ant concavity Inc bone density in area compressed
37
Stable vs. Unstable fracture
Fractures in C3-T1 that only disrupt one column are more stable More than one column disrupted is unstable C1 C2 doesnt follow this though
38
Flexion teardrop
More common and more severe fractures Force needed to produce it will likely also cause neuro damage Considered unstable - disrupt all 3
39
Mechanism of injury - flexion teardrop
Hyperflexion with compression - like diving into shallow water
40
Flexion teardrop - radiographic findings
Teardrop fragment ant inf portion of vertebral body which is displaced in ant direction Widening of interspinous process Cervical kyphosis Post displacement of verebral body compressing spinal cord
41
Avulsion fracture
Usually involves act of lifting heavy load with arms extended and a flexed spine position Considered a stable frcture C6/C7 are most common
42
Avulsion fracture of SP AKA
Clay Shovelers fracture
43
Bilateral facet dislocation
Dislocations of C3-C7 can occur with or without fracture
44
Bilateral facet dislocation - casue
A fracture of post portions of veretbrae and disruption of post ligaments is cause
45
Bilateral facet dislocation - stable or unstable
highly unstable - will tend to cause spinal cord injury
46
Bilateral facet dislocation - radiographic findings
Ant translation of vertebrae Widened interspinous space Locked facet joint Prevertebral soft tissue edema
47
Hyperextension injuries
Hyperextension spain Extension teardrop fracture Hangman's fracture
48
Hyperextension sprain
Ant ligaments are disrupted causing post translation of vertebrae - post subluxation
49
Extension teardrop
Forced neck extension produces an avulsion fracture of the anterioinferior portion of the vertebral body Diving accidents = common cause ALL is forcibly stretched avulsing a piece off the vertebrae
50
Extension teardrop - stable vs unstable
During active motion the fracture is stable in flexion and highly unstable in extension Most often involves C2
51
Hangmans fracture
Results when hyperextension and distraction are applied AKA traumatic spondylolisthesis of C2 Bilateral fracture of pars articularis
52
Hangmans fracture - classification
Levine Classification
53
Type I hangman
Less than 3 mm translation C2 on C3 C2-3 disc is intact Prevertebral soft tissue edema Generally stable
54
Type II hangman
``` More than 3mm translation C2 on C3 C2 C3 disc space disrupted More than 10 degrees angulation PLL rupture Prevertebral edema Unstable ```
55
Type III Hangman
All of Type II features plus bilateral facet joint dislocation Very unstable
56
Extension teardrop radiographic findings
Anterior inferior corder fracture (triangular in shape) Ant disc space widen Prevertebral soft tissue edema
57
Axial compression
Forces that are applied directly though the spine in a vertical direction Burst fracture Wedge fracture
58
Burst fracute
The compression force with high energy load causes the intervertebral discs to be driven into the vertebral body Results in vertebral fragmentation and spead to surroudnings tissues Post cortex of the vertebare is pushed into spinal cord Comminuted fracture
59
Burst fracture of C1 is known as
Jefferson fracture
60
Identification of jeffereson fracture via
Open mouth view CT scan required to see extent of damage C1 is ring so if one fracture there is probably another Unstable if transverse ligament is involved
61
Radiographic findings for jefferson
Lateral masses are split and overhang C2 | If greater than 7mm the transverse ligament is ruptures
62
AA dislocation - disorders that can lead to laxity
RA and Down Syndrome
63
OA dislocation - mechanism
typically hyperextension with distraction Seen most often in children - rupture of ligaments that stabilize occ on atlas Highly unstable and can result in death or neuro impair
64
Dens fracture
AKA peg fractures | Open mouth and CT scan recommended
65
Unilateral Facet dislocation - mechanism
hyperflexion and rotation Facet capulse and post ligaments on one side are disrupted Cuases the sup facet to move over the inf facet and lock into place
66
Radiogaphic findings for unilateral facet dislocation
Inc interspinous distance Ant translation of vertebral body Bow tie effect - lateral masses overlap
67
Dens fracture classification system
Anderson and D Alonzo
68
Type 1 dens fracture
tip of dens is avulsed Fracture site is above trans lig so is stable Less then 8% of dens fracture
69
Type 2 dens fracture
common Occurs through base of dens hard to heal and high degree of non-union Unstable
70
Type 3 dens fracture
location across lateral masses and base of dens has better chance of healing than type II

Semester 3 PM Exam 2 (4 decks)

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