Spinal Trauma Flashcards
(96 cards)
1
Q
must be cleared first for stability before
other views are attempted
A
Lateral cervical view
2
Q
before ruling out
significant spinal injury don’t perform what views?
A
flexed and extended views
3
Q
often required to fully
evaluate cervical spinal injury
A
Reconstructed CT scanning w/o contrast
4
Q
Prevertebral (retropharyngeal & retrotracheal) soft tissues
evaluation
(significant indicator of underlying cervical injury)
A
Adults: no more than 22-mm at C6-C7 and no more than 7-mm at C2
5
Q
soft tissue thickness at C2 should measure less than
A
50% of vertebral body width
6
Q
At C6 or C7 soft tissues should measure less than the width of the
A
adjacent vertebral body
7
Q
is loss of cervical lordosis is a reliable
indication of injury?
A
NO
8
Q
seen in >20% of normal cervical radiographs
A
Absent lordosis
9
Q
may cause flattening and/or reversal of lordosis
A
Post-traumatic cervical muscle spasm or
DDD
10
Q
A reliable way to evaluate alignment of C/S is to look at what 4-lines?
A
- Anterior vertebral line
- Posterior (George’s) vertebral line
- Spinal laminar line
- Posterior spinous process line
11
Q
may strongly indicate disruption of the
PLL, capsular and interspinous ligaments
A
Posterior disc space widening and fanning of the spinous
processes esp. at C3-C6
12
Q
may indicate marked rotational
deformity and facet dislocation
A
Abrupt change in facet orientation
13
Q
“double
SP sign” indicating
A
SP avulsion
14
Q
C2-Odontoid normally it tilts ____ slightly
A
back
15
Q
If the Odontoid leans more anterior, suspect
A
odontoid fracture
16
Q
In adults C1-C2 distance on lateral view is approx.
A
2.5-mm
(should not
increase on flexion)
17
Q
In children the C1-C2 distance may be up to
A
5-mm and may change by 1-2-mm in flexion
18
Q
In children C1 lateral masses may slightly
A
overhang
19
Q
what system can establish if the fracture is stable or unstable?
A
3-column Denis classification system
20
Q
How can we establish if the fracture is stable or unstable?
A
stable fracture if only 1-column is injured
21
Q
most spinal fractures may
involve some component of
A
flexion injury
22
Q
S.C.I.W.O.R.A.
A
serious trauma including cord damage w/o radiographic
abnormality
23
Q
posterior arch, Jefferson “burst” fracture, anterior arch lateral
mass fractures
A
C1-atlas
24
Q
Hangman’s, Odontoid process, teardrop fracture
A
C2-axis
25
compression wedge or burst, flexion teardrop, pillar, isolated
lamina & TP, Clay Shoveler’s fractures
C3-C7
26
potentially unstable upper cervical injury
Occipital condyle fracture
| x-ray may miss this
27
Occipital condyle fractures may be encountered more frequently due to
MVA injuries
28
Usually associated with severe injuries to facial skeleton and the
skull due to significant trauma
Occipitovertebral dissociation (less common but often fatal)
29
m/c fracture of the Atlas (>50%)
Bilateral fracture of the posterior arch of C1
30
Bilateral fracture of the posterior arch of C1 should not be confused with
Jefferson C1 fracture
31
mechanism of a bilateral fracture of the posterior arch of C1
extension/compression of the C1 arch by the occiput
32
• Relatively stable injury but may have >80% association with other
cervical fractures
Bilateral fracture of the posterior arch of C1
33
burst fracture of C1
Jefferson fracture
34
represents an osseous ring that ossifies between 3-6 years of
age (an may fracture)
burst fracture of C1 (Jefferson fracture)
35
“diving head first”, compression of occipital condyles
| into lateral masses of C1
burst fracture of C1 (Jefferson fracture)
36
overhanging C1 masses, if >6-mm combined, suspect
transverse
| ligament damage and marked instability
37
may occur due flexion or extension or a
| combination of forces
Odontoid process fracture
38
less common, involves avulsion of the tip. May be unstable
| contrary to some views
Type 1 - Odontoid process fracture
39
most common and most unstable through the base of the
odontoid process and may involve cruciate ligament.
(>23% missed cervical fractures)
Type 2 - Odontoid process fracture
40
through the base into the body and lateral masses.
Type 3- Odontoid process fracture
41
Can be
stable and carries best healing potential due to greater fracture surface
and vascularization.
Type 3- Odontoid process fracture
42
not to be confused with Dens fracture
Mach line (effect)
43
Not to be confused with Type 1 odontoid fracture.
Persistent ossiculum terminale.
44
traumatic spondylolisthesis of C2.
Hangman's fracture
(Most cases
related to MVA)
45
Due to hyperextension and traction of the upper cervical spine leading to
b/l break of pars interarticularis of C2 and disruption of the discovertebral
junction
Hangman's fracture
46
vertebral artery
| damage may occur If fracture line extends to the
foramina intertransversaria
47
b/l break in pedicles and lamina of C2 and spondylolisthesis
| of C2 body
spondylolisthesis of C2. (Hangman's fracture)
48
A sliver of bone may be noted at anterior C2 body due to associated extension
teardrop fracture caused by
avulsion of the Anterior Longitudinal
| Ligament attachment
49
hyperextension of the C/S may cause avulsion of the inferior-anterior corner of the
vertebral body
Extension teardrop fractures
| unstable in extension
50
Extension teardrop fractures can be associated with Hangman's fracture, especially
in older patients due to
spondylosis
51
one of the most severe injury of the cervical
| spine, often causing anterior cervical cord syndrome and quadriplegia.
Flexion teardrop fracture (80% paralyzed on site)
52
typically occurs from severe flexion and
| compression, most commonly at C5-6
Flexion teardrop fracture
53
Flexion teardrop fracture may cause
anterior cord damage due to posterior
| displacement of vertebral body fragments
54
fracture of antero-inferior vertebral body
(teardrop sign)
55
Focal cervical kyphosis
fracture of antero-inferior vertebral body
56
- posterior cervical displacement above the level of injury
Fanning of interspinous processes
intervertebral disc space narrowing
disruption of the spinolaminar line
anterior dislocation of the facet joints
fracture of antero-inferior vertebral body (teardrop sign)
57
seen on lateral radiographs as an oblique lucency
| through the spinous process, usually of C7.
Clay Shoveller Fracture
58
most typical mechanism of Clay Shoveller Fracture
sudden muscle contraction
| occasionally direct blows to SP
59
Hyperflexion injuries to the vertebral body resulting from axial loading
Compression “Wedge fracture”
60
Compression “Wedge fracture" most commonly affecting the
anterior body aspect
61
wedge fractures are considered a
single-column (i.e. stable) fracture
62
Compression “Wedge fracture” may occur in the C/S but typically seen in the
thoracic and T/L region
63
no posterior body retropulsion, wedging of the anterior body
| typically of superior end-plate impaction
Compression “Wedge fracture”
| stable and no neuro
64
Compression “Wedge fracture” may share great
| resemblance to
osteoporotic thoracic compression fracture
65
more common in the thoracolumbar region and
| considered stable.
Simple wedge fractures
66
type of comminuted compression fracture which results
in disruption of the posterior vertebral body cortex with retropulsion of
fragments into spinal canal
Burst fractures
67
When burst fractures involve the thoracolumbar level, it tends to occur between
T9 and
| L5 level.
68
result of high energy axial loading and nucleus is driven into the vertebral body below
burst fracture
69
All patients with burst fracture require a
CT to assess
70
burst of vertebral body fragments well demonstrated
on axial CT and
loss of posterior vertebral height on lateral radiographic views
burst fracture
71
retropulsed fragments in the spinal canal
burst fracture
72
Interpedicular distance widening
burst fracture
73
comminuted fracture often with posterior displacement (retropulsion)
of fragments and potential cord damage
Burst fracture
74
flexion distraction type of injury
Bilateral cervical facet dislocation
75
Results from hyperflexion & traction and also reported buckling force to be
involved
facet dislocation
76
If flexion/distraction injury occurs whilst cervical rotation is present- a
______ facet dislocation may occur.
unilateral
77
may tear capsular ligaments leading to facet of the
| above vertebra overriding or perched on the one below
Flexion/distraction force
78
may be seen radiographically with
| perched and dislocated facets
50% anterolisthesis of vertebral body
79
Overriding facets may typically produce _______ appearance due to sudden facet ______ on lateral cervical view
“bow tie”, rotation
80
Perched facet joint is a vertebral facet joint whose inferior articular
process appears to sit (perched) on the
ipsilateral superior articular
| process of the vertebra below.
81
Any further anterior subluxation will result in dislocation, becoming locked in this position leading to
“Jumped facets”
82
will lead to overriding and “locked facets” frequently
| seen in complete bilateral facet dislocation
“Jumped facets”
83
commonly at C4-C7 with C6 (40%) cases
Cervical articular pillar fracture
84
Fractures of the spinous process of a lower cervical vertebra (usually C7)
Clay-shoveler fracture
85
usually an avulsion-pull fracture
Clay-shoveler fracture
| often goes unrecognized
86
seen on lateral views as an oblique lucency through the
| spinous process, usually of C7
Clay-shoveler fracture
87
flexion-distraction type injury of the spine that extends through to involve all three spinal columns
Chance (seat-belt) fracture
88
Unstable injury and have a high association with intra-abdominal trauma
(esp. pancreatic and duodenal injury)
Chance (seat-belt) fracture
89
occurs from a flexion injury of the vertebral body and distraction
type injury of the posterior elements
Chance (seat-belt) fracture
90
back seat passenger restrained by a lap
seatbelt and involved in a motor vehicle accident or that of a person who
has fallen from a height
Chance (seat-belt) fracture
91
TL junction (T12-L1) contributes to ___ % of cases of chance fracture
50%
92
anterior wedge fracture of the vertebral body with horizontal
fracture through posterior elements or distraction of facet joints, disc and
spinous processes
chance (seat-belt) fracture
93
modality of choice for chance fracture
CT scanning
94
treatment for chance fracture
surgical or fibreglass plaster with some extension
95
Radiographically anterior body narrowing and fracture through posterior elements
Chance (seat belt)
96
Radiographic evaluation of “whiplash injury” is often
unrewarding
