1 CERVICAL SPINE RTEC 124 WEEK 6 Rev

1 CERVICAL SPINE RTEC 124 WEEK 6 Rev 2010

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4 Review the anatomy

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6 Direction of cervical zygapophyseal joints seen in LATERAL position seen in OBLIQUE

7 INTERVERTEBRAL FOREAMEN AP = SIDE UP PA = SIDE DOWN

8 POSITIONING FOR CERVICAL SPINE • ROUTINE “ 5 views” (arthritis, etc) • AP “ODONTOID” • AP (axial) • BOTH OBLIQUES, • LATERAL (UPRIGHT) • SWIMMERS – LATERAL (if needed) • • ROUTINE “ 2 view” AP (axial) , AP “ODONTOID”, LATERAL (UPRIGHT) SWIMMERS – LATERAL (if needed) • TRAUMA • CROSS TABLE LATERAL (minimum) • “ CLINICAL “ ROUTINE • “LATERAL (UPRIGHT) pt is ↑ ┴ C/R PT is ↑ or ↓ • AP “ODONTOID” ┴ < C/R (15 – 20 º) ↑ (AP ) • AP (axial) • BOTH OBLIQUES, • SWIMMERS – LATERAL • (if needed) pt is ↑ or ↓

9 Done supine or upright

10 May be more difficult to do upright - use a sponge on back of head to relax neck muscles May need to use a ┴ or C/R < 5º ↑ To move incisors off dens

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13 Done supine or upright

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17 LATERAL C. SP

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19 Some rotation ((zygo & pillars not s/i) & TILT

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21 C. SP OBLIQUES

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24 With head in true lateral – Look at the mandible position

25 With head in oblique – Look at the mandible position

26 “SWIMMERS FOR C. SP TWINNING & PAWLOW METHODS

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28 Name of the position ?

29 C/R @ C 7 - T 1 PERP OR ANGLED 5 CAUD

30 Alternate Positioning FLEXION & EXTENSION Purpose? Flexion and extension views should be obtained in awake and cooperative patients to further evaluate for injury. Flexion views will exaggerate the radiographic abnormalities and extension views will reduce them. Anterior subluxation & check for ROM

31 Alternate Positioning Fuchs vs Judd Demonstrates? MML ┴ to IR MML // with CR

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33 AP oblique atlanto-occipital joint.

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35 BEST SEEN

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37 SPINAL INJURY PT an overview : this will be covered in more detail in the TRAUMA lecture

38 “TRAUMA SERIES” • SHOULD CONSIST OF 2 “views” /projections • 90º TO EACH OTHER • MOVE C/R AND CASSETTE – • NOT THE PATIENT !!! “TAKE IT AS IT LIES” “DO NOT HARM”

39 When the patient is a true “trauma” care must be taken not to move the patient At a minimum the AP’s & laterals are done with the C. COLLAR in place Then after CLEARED by the MD – you may proceed (? w/o? collar? ? ? ) May be required to repeat AP & Lat again without collar artifact

40 X-TABLE LATERALS AKA ‘DORSAL DECUBITUS” CERVICAL SPINE Can be done with or without a grid With Comp Rad probably need a grid

41 X-table Lateral C. SP

42 Peds pt with comp Dis loc C-2 C -3 Pt died on table

43 For Odontoid in C collar

44 X-table lat –”Swimmers” Note: Mrs. Charman’s tip : Place forearm on forehead to prevent superimposition of humerus + c. sp

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46 Alternate “Trauma Views” OBLIQUE – TRAUMA C. SP

47 Pathology Terms • HANGMANS FX • JEFFERSON FX • CLAY SHOVELER’S FX • SUBLUXATION • COMPRESSION FX • REVIEW PG # 388 Merrills • • • Neck pain Many causes including Trauma MVA, sports, falls degenerative disease Infections Neoplasms congenital variations, inflammatory arthritis psychic tension • Etc………

48 Whiplash Injuries” more pathology C. SP • Passengers forewarned of an impending rear collision can potentially protect themselves by flexing the neck and tucking the chin against the chest. An extended head potentiates the risk of ligamentous rupture and articular dislocation. Areas of preexisting degenerative disease are most susceptible to injury. • radiculopathy- segmental motor or sensory signs associated with a root disorder. (numbness in hands/arms) • Tear drop fx from Extreme flexion

49 Spinal Cord C-1 ring fx

50 • . AVULSION FX c-1 • A fracture involving the entire anterior arch is unstable

51 • A wedge fracture of a vertebra is caused by compression between two other vertebrae • Surgical repair • After subluxation or • Wedge fx

52 HANGMAN’S FX C. SP The hangman´s fracture is located in the pedicles of C 2, with C 2 displacing anteriorly on C 3

53 Jefferson’s fx a burst fx of C-1 –atlas = results from compression of the C. SP – may also be associated with fx of C-2 (axis) May or may not involve the transverse ligament

54 Jefferson fracture lateral displacement of lateral masses of C 1 bilaterally (white lines).

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56 Image Critique (Elsevier)

57 Image Critique (Elsevier) There are two possible reasons: excessive rotation of the upper torso beyond a 45° oblique position or incorrect or inadequate CR angle Shoulders are not rotated away from the cervicothoracic region, preventing clear image of the spine.

58 Excessive flexion excessive extension of neck

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60 excessive flexion of neck excessive extension of neck

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62 Some rotation & Tilt

63 C 7 not seen Use weights (5 -10) lbs if possible Expose on expiration

64 Position? TOO much rotation (look at spinous Process) Not enough rotation to 45º Looks like “AP”

65 Upper OK – lower - too much rotation of body (Done PA ) CR < wrong way

66 LAO Head is lateral Atlas & post arch obscured Cortex of skull on s/I Mandibles not s/I 1 st Tsp not shown (head tiled away from IR too much) CR/IR too superior Keep IP line ┴ to IR & move CR ↓

67 Some studies of spinal trauma have recorded a missed injury rate as high as 33%.

68 C 1 c 2 sublux c 4 wedge fx

69 Fracture of the pedicles with dislocation of C 5 and C 6. Note superior portion of C 7 shown on this image.

70 Dislocation of the C 3 and C 4 articular processes Note that C 7 is not well demonstrated

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