radiology 3a

• a synovial joint between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it
• sup facet is more medial than the inf

• cary axial load of body
• limit ROM of spine
• form back border of intervertebral foramen (can cause LATERAL CANAL STENOSIS when hypertrophied from osteoarthritis)

lateral canal stenosis

raised lateral edges of vertebral bodies in the cerebral spine

holes in the TPs of the 7 cervical vert

column-like structures formed by the rticulation of the superior and inferior articular processes of the vertebrae.

• no body
• sup articular facets articulate w/ occipital condyles of skull
• head moves back/forward on this vert

• forward and back: atlas
• side to side: axis

• the SPs of C3-6
• axis too, according to the pics

• vertebral artery & vein
• nerve

x-ray w injected contrast

• AP
• lateral
• ondontoid (open mouth)
• R and L oblique (to look at neural foramen, bc they're on anlges)
• Swimmer's (arms flexed, one ot 45, one to 135)
• Flex and Ext of neck

• 2 is min, but some institutions do 5
• if history of trauma, image to the top of T1

• trachea
• on a lat view it's ant to the spinal cord

it comes up from the ant portion of C2 and skewers C1

• anterior longitudinal line (ant of vert body)
• posterior long line (post of vert body)
• spinolaminar line (post wall of spinal canal)
• spinous process line (along post edges of SPs)

• osteophytes
• disc space narrowing
• sclerosis of end plates ( end plates are inflamed, an dthis leads to the ends of bones getting thicker, denser, whiter, more irregular)

• increased density (more radiodensity inside the trabecular space)
• loss of trabecular pattern (the white of the rim goes within)

• narrowed: degenerative disease
• widened: trauma

only when they're abnormally calcified

• loss of disc ht
• sclerosis of end plates
• hypertrophic changes (osteophytes)

• are there neurological signs or symptoms?
• abnormal DTRs?
• motor > sensory changesbowel/bladder incont
• difficulty w walking (not pain related)

• chronic neck pain -- get an x-ray
• if no neuro signs/symptoms -- get nothing else
• if there are some -- get an MRI

• 1 column injury: stable
• 2 column injury: unstable (probably)
• 3 column injury: unstable
•  (unstable doesn't necessarily mean surgery)

• ant column: ALL, ant annulus, ant 2/3 of vert body
• middle column: post 1/3 of vert body, post annulus, post long lig
• post column: posterior elements of the vert (everything post the foramen)

• assess severity of trauma (NEXUS or CCR)
• get CT for all significant trauma
• MRI may be helpful in some
• for kids, get plain x-rays unless knowon to have other spinal fx
• consider the possibility of associated vascular injury in the c-spine - CTA or MRA of neck vessels

• 1 - a chip off the top
• 2 - the whole top detaches
• 3 - the top breaks, taking a lower portion with it
• 2 is the most unstable

retropulsion pushes on the cord, giving compression

• from hitting chin on dashboard, or from hanging
• fracture thru pedicles of C2,
• ant sublux of C2

• hyperflexion causes avulsion of portion of SP by interspinous lig
• C7-T1
• (from excessiv forced flexion???)

• extreme hyperflexion and axial load injury --> facets lock in abnormal pos, it's unstable
• locked facets (the inf of the upper one is now ant of the sup lower, where it should be post)
• perched (it's delicately sitting on top)
• subluxated (post but high)

• teardrop fx of inf ant vert body
• spinal cord compression bc the rest of the body moves post
• SP of that vert breaks

• one of the most unstable c-spine injuries
• all 3 columns are disrupted
• often cord injury or paralysis

• not as severe as the flexion teardrop
• it's stable in flexion and unstable only in hyperextension

this was the basics of the slides. Before the test you must review them again and familiarize yourself with the images.