Transcript cervical spine - El Camino College

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CERVICAL
SPINE
RTEC 124
WEEK 6
Rev 2010
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Review the
anatomy
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Direction of cervical zygapophyseal joints
seen in LATERAL position
seen in OBLIQUE
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INTERVERTEBRAL FOREAMEN
AP = SIDE UP
PA = SIDE DOWN
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POSITIONING FOR CERVICAL SPINE
• ROUTINE “5 views” (arthritis,
etc)
• AP “ODONTOID”
• AP (axial)
• BOTH OBLIQUES,
• LATERAL (UPRIGHT)
• SWIMMERS – LATERAL (if
needed)
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•
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•
ROUTINE “2view”
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 ↓
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Done supine or
upright
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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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Done supine or upright
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LATERAL
C.SP
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Some rotation ((zygo & pillars not s/i)
& TILT
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C.SP OBLIQUES
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With head in true lateral –
Look at the mandible position
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With head in oblique –
Look at the mandible position
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“SWIMMERS FOR C.SP
TWINNING
&
PAWLOW METHODS
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Name of the position ?
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C/R @ C7- T1
PERP OR
ANGLED 5
CAUD
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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
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Alternate
Positioning
Fuchs vs Judd
Demonstrates?
MML ┴ to IR
MML
//
with CR
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AP oblique
atlanto-occipital joint.
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BEST SEEN
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SPINAL INJURY PT
an overview :
this will be covered in more detail in the
TRAUMA lecture
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“TRAUMA SERIES”
• SHOULD CONSIST OF 2
• 90º TO EACH OTHER
“views” /projections
• MOVE C/R AND CASSETTE –
• NOT THE PATIENT !!!
“TAKE IT AS IT LIES”
“DO NOT HARM”
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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
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X-TABLE LATERALS
AKA ‘DORSAL DECUBITUS”
CERVICAL SPINE
Can be done with or without a
grid
With Comp Rad probably need a
grid
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X-table Lateral
C. SP
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Peds pt with comp Dis loc C-2
C-3
Pt died on table
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For Odontoid in C collar
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X-table lat –”Swimmers”
Note: Mrs. Charman’s tip :
Place forearm on forehead to prevent superimposition of humerus + c.sp
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Alternate “Trauma Views”
OBLIQUE – TRAUMA C.SP
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Pathology Terms
• HANGMANS FX
• JEFFERSON FX
• CLAY SHOVELER’S
FX
• SUBLUXATION
• COMPRESSION FX
• REVIEW PG # 388
Merrills
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•
•
•
•
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•
•
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Neck pain
Many causes including
Trauma MVA, sports, falls
degenerative disease
Infections
Neoplasms
congenital variations,
inflammatory arthritis
psychic tension
• Etc………
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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.
• radiculopathysegmental motor or
sensory signs associated
with a root disorder.
(numbness in
hands/arms)
• Tear drop fx
from Extreme flexion
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Spinal Cord
C-1 ring fx
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• .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
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HANGMAN’S
FX C.SP
The hangman´s fracture
is located in the
pedicles of C2, with C2
displacing anteriorly on
C3
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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
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Jefferson fracture
lateral displacement of lateral masses of
C1 bilaterally (white lines).
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Image Critique (Elsevier)
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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 angle
Shoulders are not rotated away
from the cervicothoracic region,
preventing clear image of the
spine.
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Excessive flexion
excessive extension
of neck
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excessive flexion of neck
excessive extension of neck
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Some rotation & Tilt
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C 7 not seen
Use weights (5-10) lbs
if possible
Expose on expiration
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Position?
TOO much rotation (look at spinous
Process)
Not enough rotation to 45º
Looks like “AP”
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Upper OK – lower - too much rotation of body
(Done PA ) CR < wrong way
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LAO
Head is lateral
Atlas & post arch obscured
Cortex of skull on s/I
Mandibles not s/I
1st Tsp not shown
(head tiled away from IR too much)
CR/IR too superior
Keep IP line ┴ to IR & move CR ↓
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Some studies of
spinal trauma have
recorded a missed
injury rate as high
as 33%.
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C1 c2 sublux
c4 wedge fx
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Fracture of the pedicles
with dislocation of C5 and
C6. Note superior portion
of C7 shown on this
image.
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Dislocation of the C3 and C4
articular processes
Note that C7 is not well
demonstrated
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