Spine

Question 1

Standing Lateral Cervical View

Answer 1

head in neutral beam to center of C4
Demonstrates vertebral bodies, apophyseal joints, spinous processes, intervertebral disk
C7 should ALWAYS be demonstrated

Question 2

Table Lateral C View

Answer 2

Supine with head in neutral, beam directed 2.5-3 cm caudal to mastoid tip

Question 3

5 contour lines of cervical spine

Answer 3

Retropharyngeal space <7mm
Retrotracheal space <22mm adults or <14mm children
1 anterior vertebral line
2 posterior vertebral line
3 spinolaminar line
4 posterior spinous line
5 clivus-odontoid line

Question 4

Chmerlain Line

Answer 4

posterior margin of foramen magnum to dorsal margin of the hard palate
Odontoid process shoud not project above this line more than 3mm or it indicates AA impaction

Question 5

McRae Line

Answer 5

line btwn anterior and posterior margin of foramen magnum

Odontoid process should be just below or is indicates AA impaction

Question 6

AP Cervical View

Answer 6

pt supine or standing
beam directed at C4 at 15-30 degrees cephalad
Demonstrates C3-C7 vertebral bodies and intervertebral spaces
C1-C2 not adequately viewed

Question 7

Open Mouth View

Answer 7

Pt opens mouth as wide as possible beam directed at midpoint of open mouth
Demonstrates C1-C2

Question 8

Fuchs View

Answer 8

Pt. supine w/ neck hyperextended, beam directed vertically just below chin
Demonstrates Odontoid

Question 9

Oblique View

Answer 9

Pt rotated 45 degrees with beam directed at C4 15-20 degrees cephalad (R rotation demonstrates L foramina)
Demonstrates Foramina and apophyseal joints

Question 10

Swimmers View

Answer 10

Pt prone with 1 arm abducted 180 degrees and other at side, beam directed horizontally at axilla
Demonstrates C7, T1, T2

Question 11

Occipital Condyle Fx Types

Answer 11

See Image

Question 12

Jefferson Fx

Answer 12

MOI axial load to head and occipital condyles causing symetrical fxs of anterior and posterior arches of C1 and disruption of transverse ligaments

Question 13

Odontoid Fx Types

Answer 13

Type 1 - through part of odontoid
Type 2 - whole odontoid breaks off
Type 3 - Fx below odontoid

Question 14

Hangman’s Fx

Answer 14

MOI - Hyperextension and distraction

Fx identified through the pedicles of C2 and associated ligament disruption

Question 15

Burst Fx

Answer 15

Seen at C3-C7
Nuleolus pulposes driven through Fx vertebral plate into vertebral body causing comminuted Fx
CT is best for imaging these

Question 16

Teardrop Fx

Answer 16

MOI - Compression and Flexion
Most severe and unstable C spine injury
Posterior displacement of spinal canal, Fx of posterior elements and disruption of soft tissue
Best viewed with Lateral radiograph

Question 17

Clay-Shovelers Fx

Answer 17

MOI - Acute powerful flexion or direct blow to C spine
Stable Fx with posterior ligament complex intact
Best view - lateral

Question 18

Compression (wedge) Fx

Answer 18

MOI - Hyperflexion of C-spine
Anteriro compression of vertebral body
Posterior ligament complex stretched
Best view - lateral

Question 19

C Spine Step 1

Answer 19

Age over 65
Dangerous Mechanism
Numbness or tingling in extremities

Yes to any = Xray

Question 20

Dangerous Mechanism Definition

Answer 20

Fall from 3 ft or higher
Bicycle collision
Axial load to the head
MVA involving high speed, rollover or ejection

Question 21

C Spine Step 2

Answer 21

Simple rear-end MVA
Pt ambulatory at any time since injury
Delayed onset of neck pain
Pt in sitting position in ER
No midline cervical tenderness
No to all? Xray

Question 22

C Spine Step 3

Answer 22

Able to actively rotate 45 degrees each way?

No? Xray

Question 23

Thoracic AP

Answer 23

Supine with *knees flexed
Beam directed vertically 3cm above xiphoid process
Demonstrates vertebral endplates, pedicles and intervertebral disks

Question 24

Thoracic Lateral View

Answer 24

Pt standing with arms elevated beam directed at T6 with 10 degrees cephalad

Question 25

AP Lumbar View

Answer 25

Pt supine with knees flexed to eliminate lordosis beam directed at center of abdoment at level of iliac crests Demonstrates: Vertebral bodies and end plates, transverse processes, intervertebral disk space, spinous process, pedicles

Question 26

Cupids Bow

Answer 26

Characteristic configuration of end plates of L3-L5 Demonstrated on inferior aspects Absence indicates possible compression Fx

Question 27

Lateral View of Lumbar

Answer 27

Pt in sidelying with knees and hips flexed to eliminate lordotic curve, beam vertical at L3 Demonstrates: Vertebral bodies, Pedicles, Spinous Processes, Intervertebral foramina, disk space

Question 28

Oblique view of Lumbar

Answer 28

Pt 45 degrees from prone beam directed at L3 Demonstrates: Facets, Superior-Inferior articular process, Pedicles, Pars interarticularis "Scotty Dog"

Question 29

Lumbar Burst Fx

Answer 29

MOI: Axial compression or a combo of compression w/rotation or anterior or lateral flexion Hallmark: Widening of interpediculate distance

Question 30

Seatbelt Fx

Answer 30

Horizontal splitting of the vertebra beginning in spinous process or lamina and extending through the pedicles and vertebral bodies

Question 31

Spondylolysis

Answer 31

Defect in the pars interarticularis Andvanced form - Spondylolisthesis 90% occur at L4-L5 or L5-S1

Question 32

Spinous process sign

Answer 32

true spondy has defect in pars interarticularis

Question 33

Grading a Spondy

Answer 33

Divide vertebral body into 4. Grade 1-4 based on how many quarters have slipped off

Question 34

Spondylosis Deformans

Answer 34

degenerative condition, large osteophytes on anterior aspect of adjacent vertebral bodies Anterior disk herniation