Transcript اسلايد شماره 12

Lines of Mensuration
Continued
• Cervical Spine Lordosis
– Depth Measurement (range of 7=17)
– Method of Jochuvisen (range 1-9)
• anterior body of atlas
• anterior/superior C7
• measure C5 to line
– Angle of curve - each disc space
– C1-C7 lordosis
Lines of Mensuration
Continued
• Prevertebral space maximum
– C1 - C5 - 7mm
– C5 - C7 - 20mm
• Penning Analysis
COMMON CONDITIONS
• Postural
• AP Curves
– Normal - lordosis with dens over
anterior/superior corner of C7
– Abnormal - hy[erlordosis, hypolordosis,
reversal
Common Conditions Continued
– Hypolordosis/Reversal due to:
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trauma
muscle spasm
degenerative joint disease
posterior laminectomy (with decreased or reusal of the
sagittal curve there is a decreased response to
corrective decompression
Common Conditions Continued
– Sagittal - curves, scoliosis, tower
– Dr. Wittmer study
– Pre and post cervical spine molding
• no clear evidence of benefit
Common Conditions Continued
• Degenerative Joint Disease
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Spondylosis
Uncovertebral arthrosis
Facet arthrosis
Motion alteration
Compression effects
X-ray often NOT predictive
Common Conditions Continued
• ADI
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Child up to 5.0mm
Adult up to 3.0mm
Stress view in flexion/extension
Decreased ADI - arthritis
Increased ADI
TRAUMA with the rupture of
the transverse ligament
• Much less common than Den’s fracture
• Transverse ligament rupture much greater
threat to life
• Guillotime effect - Guillotine
• Most common type is Type II Den’s
fracture, its unstable
• Type I and Type III is stable
• Type I israre, Type III is a close second
INFECTION:
INFLAMMATORY
ARTHRITIDE
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Rheumatoid arthritis
Psoriasis
Ankylosing spondylitis
Reiter’s
Trauma
• Jefferson’s Fracture
– C1 ring fracture (significant neurological deficit
or death, which is uncommon
– Decompression
– Greater or equal to two fracture locations
– Axial load
• Posterior Arch Fracture
– most common
– 80% will have other cervical spine fracture
Hangman’s Fracture
(traumatic spondylolisthesis)
• C2 fracture among most common cervical
spine fractures
• 40% of axis fractures are hangman
• result from MVA with abrupt deceleration
and/or compression and hyperextension
• bilateral pedicle fracture
– 25%