Cervical Spine Presented by M A Kaeser DC
Cervical Spine Presented by M. A. Kaeser, DC Spring 2009
Radiographic Anatomy n APOM • • • Dens C 1 Lateral masses C 1 Posterior arch C 1 Anterior arch C 1 TPs Atlanto-occipital joint Mastoid air cells C 2 spinous process C 2 transverse foramen Mandible
Radiographic Anatomy n Lateral view C 1 posterior tubercle C 1 posterior arch C 1 lateral mass Dens C 2 -C 7 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
Radiographic Anatomy http: //files. abstractsonline. com/CTRL/12/6/B 55/E 60/AEE/ 48 C/3 B 7/51 F/1 B 1/ADD/157/40/a 1198_19. JPG
http: //www. drkassicieh. com/images/MRI-Cervical-spine. jpg
http: //www. jbppni. com/content/figures/1749 -7221 -2 -17 -1 -l. jpg
Level of C 5/6 Disc n n n n n 1 = SCM 2 = CCA 3 = Thyroid cartilage 4 = Laryngopharynx 5 = Piriform recess 6 = Trapezius 7 = SP 8 = TP 9 = C 5/6 disc 10 = Vertebral a.
Level of C 4 n n n n n 1 = vertebral artery 2 = mandible 3 = hyoid bone 4 = laryngeal space 5 = ICA 6 = IJV 7 = body C 4 8 = Spine 9 = Lamina 10 = SCM
Radiographic Anatomy n APLC • • • SPs Laminae Pedicles TPs Articular pillar Uncovertebral joints Costotransverse joint Trachea IVFs Lung apices http: //www. e-radiography. net/technique/spine-
Specific Problems n Dislocations • Atlantooccipital dislocation (unstable) • Facet joint dislocation (unstable)
Atlantooccipital Dislocation n Caused by complex injury Usually causes death Causes an increase in prevertebral soft tissue width
Facet Joint Dislocation n n 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
http: //sfghed. ucsf. edu/Education/Clinic. Images/Jump%20 facet %20 MRI. jpg
Fractures n n Unstable • • • Flexion Teardrop Hangman’s Hyperextension fracture dislocation Burst Jefferson’s Odontoid • • • Clay Shoveler’s Wedge Extension Teardrop Stable
Unstable Fracture n 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/ch 264 fg 8. jpg
http: //aser. mypacs. net/aser/repos/aser_repo/viz/full/0/0/2/2137. jpg
Unstable Fracture n Hangman’s • Bilateral C 2 pedicle fracture • MVAs or hangings • Anterior displacement of the anterior part of C 2
http: //www. spineuniverse. com/displaygraphic. php/4095/shaffrey_ 16 yocervicaltrauma_fig 3 b-99. jpg
Unstable Fracture n Hyperextension fracture dislocation http: //faculty. washington. edu/alexbert/MEDEX/Winter/ch 264 fg 15. jpg
http: //www. radiologyassistant. nl/images/4912 b 9174 ba 3 fextension-4. jpg
Unstable Fracture n 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/F 5/graphic-9. large. jpg
http: //www. radiologyassistant. nl/images/thmb_ 49044098 aa 1 ab. Afbeelding-9. jpg
Unstable Fracture n Jefferson’s • At least two fractures of C 1 • Secondary to an axial injury • Diving • Heavy object http: //radiographics. rsnajnls. org/content/vol 20/issue 3/images/
http: //img. medscape. com/pi/emed/ckb/orthopedic_ surgery/1230552 -1264627 -384. jpg
Unstable Fracture n Odontoid Fractures • Type 1 2 – most unstable 3 http: //www. nypemergency. org/moxiepix/b 2_3. gif
n Type I http: //download. imaging. consult. com/ic/images/ S 1933033208734189/gr 12 a-midi. jpg
n Type II http: //www. radiologyassistant. nl/images/4911 d 5 fd 8 c 73 bdens 1. jpg
n Type III http: //www. radiologyassistant. nl/images/4911 d 96 ff 25 dbdens 5. jpg
Stable Fracture n Clay Shoveler’s • Secondary to a flexion injury • Avulsion of a piece of SP • M/C in lower C/S
http: //www. mypacs. net/repos/mpv 3_repo/viz/full/57139/2856961. jpg
Stable Fracture n Wedge • Flexion injury • Compression of anterior portion of vertebral body http: //faculty. washington. edu /alexbert/MEDEX/Winter/ch 264 fg 6. jpg
Stable Fracture n Extension Teardrop • Avulsion of a piece of the anteroinferior portion of a vertebra • Often occurs at C 2 http: //www. learningradiology. com/ caseofweek/caseoftheweekpix 2008/ cow 302 lg. jpg
http: //download. imaging. consult. com/ic/images/ S 1933033207723352/gr 1 -midi. jpg
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