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Cervical Spine

Cervical Spine. Presented by M.A. Kaeser, DC Spring 2009. Radiographic Anatomy. APOM Dens C1 Lateral masses C1 Posterior arch C1 Anterior arch C1 TPs Atlanto-occipital joint Mastoid air cells C2 spinous process C2 transverse foramen Mandible.

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Cervical Spine

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  1. Cervical Spine Presented by M.A. Kaeser, DC Spring 2009

  2. Radiographic Anatomy • APOM • Dens • C1 Lateral masses • C1 Posterior arch • C1 Anterior arch • C1 TPs • Atlanto-occipital joint • Mastoid air cells • C2 spinous process • C2 transverse foramen • Mandible http://www.medi-fax.com/atlas/spinetrauma/images/X-RAY1s.jpg

  3. Radiographic Anatomy • Lateral view C1 posterior tubercle C1 posterior arch C1 lateral mass Dens C2-C7 bodies IVDs Articular pillars Facets Laminae SPs Spinolaminar line TPs Soft tissue space (PLT) Thyroid cartilage and larynx Hyoid bone Angle of mandible Mastoid air cells

  4. http://www.drkassicieh.com/images/MRI-Cervical-spine.jpg

  5. http://www.jbppni.com/content/figures/1749-7221-2-17-1-l.jpg

  6. Level of C5/6 Disc • 1 = SCM • 2 = CCA • 3 = Thyroid cartilage • 4 = Laryngopharynx • 5 = Piriform recess • 6 = Trapezius • 7 = SP • 8 = TP • 9 = C5/6 disc • 10 = Vertebral a.

  7. Level of C4 • 1 = vertebral artery • 2 = mandible • 3 = hyoid bone • 4 = laryngeal space • 5 = ICA • 6 = IJV • 7 = body C4 • 8 = Spine • 9 = Lamina • 10 = SCM

  8. Radiographic Anatomy • APLC • SPs • Laminae • Pedicles • TPs • Articular pillar • Uncovertebral joints • Costotransverse joint • Trachea • IVFs • Lung apices http://www.e-radiography.net/technique/spine/spine-

  9. Specific Problems • Dislocations • Atlantooccipital dislocation (unstable) • Facet joint dislocation (unstable)

  10. Atlantooccipital Dislocation • Caused by complex injury • Usually causes death • Causes an increase in prevertebral soft tissue width

  11. Facet Joint Dislocation • Three types • Subluxed facets, perched facets, locked facets • Best seen on lateral view • Step deformity, >3 mm • Occur secondary to hyperflexion • Disruption of ALL, IVD and posterior ligaments

  12. http://sfghed.ucsf.edu/Education/ClinicImages/Jump%20facet %20MRI.jpg

  13. Fractures • Unstable • Flexion Teardrop • Hangman’s • Hyperextension fracture dislocation • Burst • Jefferson’s • Odontoid • Stable • Clay Shoveler’s • Wedge • Extension Teardrop

  14. Unstable Fracture • Flexion Teardrop • Extremely unstable • Posterior displacement of the vertebral body Disruption of all ligaments and IVD Often results in anterior spinal cord compression http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg8.jpg

  15. http://aser.mypacs.net/aser/repos/aser_repo/viz/full/0/0/2/2137.jpghttp://aser.mypacs.net/aser/repos/aser_repo/viz/full/0/0/2/2137.jpg

  16. Unstable Fracture • Hangman’s • Bilateral C2 pedicle fracture • MVAs or hangings • Anterior displacement of the anterior part of C2

  17. http://www.spineuniverse.com/displaygraphic.php/4095/shaffrey_http://www.spineuniverse.com/displaygraphic.php/4095/shaffrey_ 16yocervicaltrauma_fig3b-99.jpg

  18. Unstable Fracture • Hyperextension fracture dislocation http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg15.jpg

  19. http://www.radiologyassistant.nl/images/4912b9174ba3fextension-4.jpghttp://www.radiologyassistant.nl/images/4912b9174ba3fextension-4.jpg

  20. Unstable Fracture • Burst Fracture • Axial injury • Loss of anterior and posterior body height Bony fragments may push on the spinal Cord M/C in mid C/S http://ajs.sagepub.com/content/32/4/1077/F5/graphic-9.large.jpg

  21. http://www.radiologyassistant.nl/images/thmb_ 49044098aa1abAfbeelding-9.jpg

  22. Unstable Fracture • Jefferson’s • At least two fractures of C1 • Secondary to an axial injury • Diving • Heavy object http://radiographics.rsnajnls.org/content/vol20/issue3/images/ large/g00mc20l16x.jpeg

  23. http://img.medscape.com/pi/emed/ckb/orthopedic_ surgery/1230552-1264627-384.jpg

  24. Unstable Fracture • Odontoid Fractures • Type 1 • Type 2 – most unstable • Type 3 http://www.nypemergency.org/moxiepix/b2_3.gif

  25. Type I http://download.imaging.consult.com/ic/images/ S1933033208734189/gr12a-midi.jpg

  26. Type II http://www.radiologyassistant.nl/images/4911d5fd8c73bdens1.jpg

  27. Type III http://www.radiologyassistant.nl/images/4911d96ff25dbdens5.jpg

  28. Stable Fracture • Clay Shoveler’s • Secondary to a flexion injury • Avulsion of a piece of SP • M/C in lower C/S

  29. http://www.mypacs.net/repos/mpv3_repo/viz/full/57139/2856961.jpghttp://www.mypacs.net/repos/mpv3_repo/viz/full/57139/2856961.jpg

  30. Stable Fracture • Wedge • Flexion injury • Compression of anterior portion of vertebral body http://faculty.washington.edu /alexbert/MEDEX/Winter/ch264fg6.jpg

  31. Stable Fracture • Extension Teardrop • Avulsion of a piece of the anteroinferior portion of a vertebra • Often occurs at C2 http://www.learningradiology.com/ caseofweek/caseoftheweekpix2008/ cow302lg.jpg

  32. http://download.imaging.consult.com/ic/images/ S1933033207723352/gr1-midi.jpg

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