Spinal Trauma

Question 1

In the cervical spine, what radiographic view must be cleared first for stability before other views are attempted?

Answer 1

Lateral cervical view

Question 2

What views should you NOT perform before ruling out spinal injury?

Answer 2

Flexed and extended views

Question 3

What kind of imaging is often required to fully evaluate cervical spinal injury?

Answer 3

Reconstructed CT scanning w/out contrast

Question 4

What kind of imaging will provide information about neurological and soft tissue damage?

Answer 4

MRI

Question 5

What is the upper limit of soft tissue evaluation of C6-C7?

Answer 5

22mm

Question 6

What is the upper limit of soft tissue evaluation of C2?

Answer 6

7mm

Question 7

How much of the soft tissue thickness at C2 should be less than in relation to the vertebral body width?

Answer 7

<50% of vertebral body width

Question 8

T/F: Loss of cervical lordosis is not a reliable indication of injury?

Answer 8

True

Question 9

What are the 4 lines to reliably evaluate the cervical spine?

Answer 9

Anterior vertebral line
Posterior (George’s) vertebral line
Spinal Laminar line
Posterior Spinous Process line

Question 10

What may strongly indicate disruption of the PLL, capsular and interspinous ligaments?

Answer 10

Posterior disc space widening and fanning of the spinous processes

Question 11

At what levels of the spine may disruption of the PLL, capsular and interspinous ligaments typically occur?

Answer 11

C3-C6

Question 12

Where does the odontoid process lean in order for you suspect an odontoid fracture?

Answer 12

Anteriorly

Question 13

What classification system indicates if a spinal fracture is stable or unstable?

Answer 13

3-column Denis classification system

Question 14

If only 1-column is injured, is the fracture stable or unstable?

Answer 14

Stable

Question 15

If 2 or more columns are injured, is the fracture stable or unstable?

Answer 15

Unstable

Question 16

T/F: the more mobile the cervical spine is, the less stable it is

Answer 16

True

Question 17

What is the most common fracture of the Atlas?

Answer 17

Bilateral fracture of the posterior arch of C1

Question 18

How does a bilateral fracture of the posterior arch of C1 come about?

Answer 18

extension/compression of the C1 arch by the occiput

Question 19

What is a burst fracture of C1 and represents an osseous ring that ossifies between 3-6 years of age?

Answer 19

Jefferson Fracture

Question 20

How does a Jefferson fracture come about?

Answer 20

“diving head first” compression of occipital condyles into lateral masses of C1

Question 21

What does an APOM view of a Jefferson Fracture indicate?

Answer 21

C1 overhanging masses

Question 22

How much overhanging of the masses of C1 need to happen in order to suspect transverse ligament damage and marked instability of a Jefferson Fracture?

Answer 22

> 6mm

Question 23

What type of odontoid process fracture involves avulsion of the tip?

Answer 23

Type 1

Question 24

What type of odontoid process fracture is the most common and most unstable through the base of the odontoid process?

Answer 24

Type 2

Question 25

What ligament may be affected with a Type 2 odontoid process fracture?

Answer 25

Cruciate ligament

Question 26

What type of odontoid process fracture is through the base into the body and lateral masses and carries best healing potential due to greater fracture surface and vascularization?

Answer 26

Type 3

Question 27

What type of fracture is a traumatic spondylolisthesis of C2 and is 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?

Answer 27

Hangman's fracture

Question 28

In a Hangman's fracture, what is an extension teardrop fracture caused by?

Answer 28

Avulsion of ALL

Question 29

What kind of fracture is due to hyperextension of the Cervical spine which may cause avulsion of the inferior-anterior corner of the vertebral body (ALL)?

Answer 29

Extension teardrop fracture

Question 30

Is an extension teardrop fracture stable or unstable in flexion?

Answer 30

Stable

Question 31

Is an extension teardrop fracture stable or unstable in extension?

Answer 31

Unstable

Question 32

What type of fracture typically occurs from severe flexion and compression with anterior cord damage that may develop due to posterior displacement of vertebral body fragments?

Answer 32

Flexion teardrop fracture

Question 33

How many people would be paralyzed at the time of a flexion teardrop fracture?

Answer 33

>80%

Question 34

What vertebral levels are the most common with flexion teardrop fracture?

Answer 34

C5-C6

Question 35

Where on the vertebral body do wedge compression fractures most commonly occur?

Answer 35

anterior body aspect

Question 36

What kind of fracture are wedge fractures considered to be?

Answer 36

Single-column fracture

Question 37

What part of spine do you typically see wedge compression fractures?

Answer 37

Thoracic and T/L region

Question 38

What type of fractures are a type of comminuted compression fracture which results in disruption of the posterior vertebral body cortex with retropulsion of fragments into spinal canal?

Answer 38

Burst fractures

Question 39

When it involves the thoracolumbar level, what vertebral levels do burst fractures typically involve?

Answer 39

T9-L5

Question 40

How does a burst fracture come about?

Answer 40

High energy axial loading

Question 41

What results from hyperflexion and traction and also reported buckling force to be involved and is a flexion/distraction type of injury?

Answer 41

Bilateral cervical Facet dislocations

Question 42

How does a unilateral facet dislocation occur?

Answer 42

Flexion/distraction with cervical rotation

Question 43

On a lateral cervical view, what appearance do overriding facets produce with facet dislocation due to sudden facet rotation with a unilateral facet dislocation?

Answer 43

Bow tie appearance

Question 44

What is a vertebral facet joint whose inferior articular process appears to sit on the ipsilateral superior articular process of the vertebra below?

Answer 44

Perched facet joint

Question 45

What is a fracture of the spinous process of a lower cervical vertebra (usually C7), and are usually an avulsion-pull fracture?

Answer 45

Clay-shoveler fracture

Question 46

What type of fracture is a flexion-distraction type injury of the spine that extends through to involve all three spinal columns and has a high association with intra-abdominal trauma?

Answer 46

Chance fracture

Question 47

What is the most common history presented with a Chance fracture?

Answer 47

Back seat passenger restrained by a lap seatbelt

Question 48

What spinal level does a Chance fracture come up in 50% of the cases?

Answer 48

Thoracolumbar junction (T12-L1)

Question 49

What type of imaging would you order for a Chance fracture?

Answer 49

CT

Question 50

T/F: radiographically, a chance fracture is an anterior wedge fracture of the vertebral body with horizontal fracture through posterior elements or distraction of facet joints, disc and spinous processes

Answer 50

True

Question 51

T/F: Radiographic evaluation of “whiplash injury” is often unrewarding

Answer 51

True