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Emergency Spinal Radiological Assessment. spine injury: location type neurologic sequelae 1. cervical...... brainstem, cord or root 2. thoracic..... cord.

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Presentation on theme: "Emergency Spinal Radiological Assessment. spine injury: location type neurologic sequelae 1. cervical...... brainstem, cord or root 2. thoracic..... cord."— Presentation transcript:

1 Emergency Spinal Radiological Assessment

2 spine injury: location type neurologic sequelae 1. cervical brainstem, cord or root 2. thoracic..... cord or root 3. lumbar conus or root C T L

3 cord injury: deficit patterns 1. normal (no neurologic injury) 2. incomplete deficit (syndromes) a. central cord b. anterior cord c. Brown-Sequard d. posterior cord e. conus/epiconus 3. complete functional transection

4 spine injury: types 1. muscular/ligamentous a. contusions b. strains c. sprains d. complete ligamentous disruption 2. fractures + / - dislocation stability: 1. stable 1. stable 2. unstable 2. unstable

5 spinal Imaging after trauma - indications 1. clinical indications a. spine-region pain b. neurologic deficit (1) radicular (2) cord c. severe multisystem injuries d. altered mental status 2. clinical rationale a. prevent cord, root injury (neurologic stability) b. prevent incapacitating deformity and pain (mechanical instability)

6 Which patients need imaging of the cervical spine? Case 1: mild/moderate trauma patient – no loss of consciousness – normal mental status (and not intoxicated) – no neck pain or tenderness – no neurologic deficit no imaging needed

7 Which patients need imaging of the cervical spine? Case 2: mild/moderate trauma patient – altered mental status (patient is obtunded and/or intoxicated) – neck pain or tenderness – neurologic symptoms or deficit

8 Which patients need imaging of the cervical spine? Case 3: severe multi-system trauma patient imaging needed

9 spinal Imaging after trauma – imaging tools 1. bony - fractures/dislocations a. X-rays – AP, lateral, open-mouth odontoid b. CT scan 2. ligamentous a. MRI scan b. flexion – extension lateral x-ray 3. disk injury a. MRI scan b. CT/myelogram

10 cervical: 7 lordotic curve thoracic: 12 kyphotic curve lumbar: 5 lordotic curve

11 spine injury: alignment 1. pre-vertebral fascia 2. anterior marginal line 3. posterior marginal line 4. spino-laminar line 5. posterior spinous line A. vertebral body width B. spinal canal diameter

12 ligamentous injury without fracture instability possible even with normal CT; early MRI helpful stabilize until neck pain resolves, assess competence of ligaments with flexion/extension X-rays or MRI

13 Bilateral facet fracture/dislocation: “jumped” or locked facets Bilateral facet fracture/dislocation: “jumped” or locked facets

14 C1 - Jefferson fracture axial loading often associated with C2 fractures assess transverse ligament

15 type I type II type III C2 - odontoid fractures/subluxations

16 C2 - Hangman’s fracture hyperextension/axial loading bilateral C2 pars interarticularis fracture unstable when: a. >3.5 mm subluxation of C2 on C3 b. >11 degrees angulation

17 Atlantoaxial subluxation Atlantodental interval (ADI) Left: Normal ADI ≤ 3 mm Right: C1-2 subluxation

18 Denis 3-column model - thoracolumbar spine one-column injury usually stable two-column injury usually unstable three-column injury unstable

19 Class A: vertebral body compression compression fracture Anterior column failure Middle and posterior columns intact Unstable if >50% compression or >20 degrees angulation burst fracture Anterior and middle column failure Retropulsion of bone into canal Often have neurologic deficit Unstable

20 Burst fracture

21 Class B: distraction (+ flexion/extension) TypesFlexion/distraction (Chance, seat belt injury) Hyperextension Three-column injury: unstable

22 flexion/distraction posterior ligamentous injury

23 Class C: three-column injury with rotation fracture-dislocation shear injury unstable neurologic deficit

24 fracture-dislocation


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