Lect. 4 Cervical Spine

Cervical Spine:
-__ vertebrae
- C_ (____): supports head, arches from bony ring
-C_(____): Dens; privot point on which head rotates
-C_-C_: share similar osseous features

T or F: ligaments show up on radiographs

___ has been found to be more specific than plain radiographs at detecting subtle injuries.
___ recommended if neurological deficit is present. Can demonstrate "position of bony fragment...injury to spinal cord, disk, and soft tissue in same exam.
____ not indicated in patients with significant injury and other imaging is available (fracture, dislocation, instability)

_______ __-Spine Rules:
-applies to patients who are alert and stable
-designed t ohelp clinicians determine if radiographs are necessary for patients who have sustained traumatic injury to head or neck.
-Meant to identify "clinically important cervical spine injry, defined as fracture, dislocation, or ligamentous instability demonstraded by diagnostic imaging.

CCR
1. Are there high risk factors
-age greater than ____ or
-paresthesias in extremities or
-dangerous mechanism of injury
-fall from >_m or __stairs
-MVA at speeds >__mph or involving rollover/ejection
-bicycle collision
-motorized recreational acccident
__ or more high risk factors present= radiographs required

CCR
2. Are ther any low risk factors that permit safe AROM?
-Able to assume sitting position in ER or
-ambulatory at any time or
-onset of neck pain not immediate or
-absence of tenderness in C-spine or
-MVA that does not include any of the following
-pushed into oncoming traffic
-hit by bus or large truck
-rollover
-hit by high speed vehicle
Cannot Assess ROM= _______ required

CCR
3. Can the patient actively rotate the neck __ degrees in both directions?
If yes= no radiographs required
If no= radiographs required

Nexus Low Risk Criteria: developed to identify patients who do not need diagnostic imaging for C-spine. Imaging is required unless patient meets all 5 of the following criteria.
1. No posterior midline _______ tenderness
2. No evidence of ______>
3. Normal level of alertness and ______.
4. No focal _______ deficit.
5. No painful ______ injuries.

Routine Radiological Eval of C-spine
Standard views:
____ view: 5 lower cervical vert, upper thoracic vert and associated ribs, medial 3rd of clavicles, and trachea.


•______ views –7 cerv vert, intervertebral disk spaces, articular pillars, facet joints, spinous processes, and paravertebral soft tissues.

Special views
•A-P ____ ____ – C1 and C2, dens
•A-P or P-A ______ views –IV foramina, uncovertebral joints, facet joints, and pedicles
•Lateral flexion and extension stress views—look for ______ ______.
•_______ Lateral –Reveals C7, T1, T2

Radiological Signs of Cervical Trauma (3 total)
1. Abnormal _____ ____: widened retropharyngeal or retrotracheal space; displacement of paravertebral fat pad; tracheal or laryngeal displacement *** sugges presence of ___ or ____.
2. Abnormal _____ alignment: loss of parallel outline on lateral view; loss of lordosis; acute kyphotic angulation c widened interspinous space; rotation of vertebral body.
3. Abnormal _____ relationships: widened atlantodental space (damage to _____ ligament); widened interspinous space; widened IV disk space; narrowed IV disk space; loss of facet jt. articulation.

Upper Cervical Fractures:
C1: ______ fracture: fracture of anterior and posterior arch of C1, results of compression force such as diving head first in shallow water.
C2: _____ fracture: 3 types, classified as stable or unstable
C2: _____ fracture: fracture of pedicles of the axis, can cause dislocatoin of C2 on C3. Hyperextension injury

Odontoid Fractures :3 types
Type __: upper dens: oblique (8%)
Type__: base of dens; transverse (59%)
Type __: body of axis, facets (33%)

Conditions with Atlanto-Axial Issues: there are 6 (4 are reasonable and the last two are dumb)

_____ ____ ____: common in most people over 60; breakdown of intervertebral disk; imaging shows hallmark sign of decreased disk space, may have Schmorll's nodes, osteophytes at uncovertebral joints and vertebral endplates, and vacuum deformity.

______ ______ disease: OA changes to facet joints; imaging hallmarks include decreased joint space, subchondral sclerosis and osteophytes

______ Encroachment: narrowing of intervertebral foramen as a result of degenerative changes of surrounding structures (DDD and/or DJD); nerve root can become compressed.

______ ______: formation of osteophytes in response to DDD; predominate location of osteophytes at areas with greater segmental mobility (C4-5, C5-6)

________ of C-spine: used for cervical trauma; shows bony injury, degree of displacement, soft tissue and spinal cord injury; most common Sagittal SE T1 and T2

Thoracic Spine: Acute LBP clincial findings
-presence of ___ ___.
-No response to __ weeks of PT intervention.
in the presence of these radiographs are indicated

T-spine views:
___: shows all 12 vertebrae, vertebral end plates, pedicles, IV disk spaces.
___: reveals all but upper 2 or 3 vertebrae, vertebral bodies, and IV disk spaces
_____ ____: (position shoulder overhead): may be done to reveal upper thoracic vertebrae.

______ vertebral body compression fractures: most common spinal injury detected on radiographs; comprise majority of vertebral fractures in thos over 60; pre-existing osteoporosis is a contributing factor; _____ forces causes 90% of this type of fx, and remaining 10% from fall or MVA.

_______ disease: common in adolescent boys and girls; symptoms of backache and thoracic kyphosis from osteochondrosis; schmorl's nodes are consistent finding.

Lumbar Spine Views:
__: shows all 5 vertebral bodies
___: shows alignment of lumbar vert and IV disk spaces
__ and __ ____: show facet articulations, pedicles, pars (___ __ fx's). These have high levels of gonadal radiation!

Scotty Dog Fx: in an oblique view of a normal lumbar spine, the outline of a scotty dog can be seen.
-the _____ process is the nose
-the ______ is the eye
-the ___ ______ is the neck
- the _____ articular facet is the ear.
- the _____ articualr facet is the front leg.

Degenerative Conditions of Lumbar Spine:
______: formation of osteophytes in response to DDD.
______: defect in pars interarticularis (scotty dog fx)
______: forward displacement of vertebra. Can result from degenerative changes and/or fracture.
_____ ____: central, intervertebral foramen, lateral or sub-articular recesses.

IVT ____ ____: protrusion of disk material through annulus; conventional radiographs poor at showing disk material but will show chronic changes to bone such as jt space changes, spondylosis, osteophytes vaccum sign and Schmorl's nodes.
___ myelography excellent for showing anatomic detail and ____ excellent at showing morphological and physiochemical changes of disk.