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1 CERVICAL SPINE RTEC 124 WEEK 6 Rev 2010. 2 3 4 Review the anatomy.

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Presentation on theme: "1 CERVICAL SPINE RTEC 124 WEEK 6 Rev 2010. 2 3 4 Review the anatomy."— Presentation transcript:

1 1 CERVICAL SPINE RTEC 124 WEEK 6 Rev 2010

2 2

3 3

4 4 Review the anatomy

5 5

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

7 7 INTERVERTEBRAL FOREAMEN AP = SIDE UP PA = SIDE DOWN

8 8 POSITIONING FOR CERVICAL SPINE ROUTINE “5 views” (arthritis, etc) AP “ODONTOID” AP (axial) BOTH OBLIQUES, LATERAL (UPRIGHT) SWIMMERS – LATERAL (if needed) 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 ↓

9 9 Done supine or upright

10 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

11 11

12 12

13 13 Done supine or upright

14 14

15 15

16 16

17 17 LATERAL C.SP

18 18

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

20 20

21 21 C.SP OBLIQUES

22 22

23 23

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

25 25 With head in oblique – Look at the mandible position

26 26 “SWIMMERS FOR C.SP TWINNING & PAWLOW METHODS

27 27

28 28 Name of the position ?

29 29 C7- T1 PERP OR ANGLED 5 CAUD

30 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 31 Alternate Positioning Fuchs vs Judd Demonstrates? MML ┴ to IR MML // with CR

32 32

33 33 AP oblique atlanto-occipital joint.

34 34

35 35 BEST SEEN

36 36

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

38 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 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 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 41 X-table Lateral C. SP

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

43 43 For Odontoid in C collar

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

45 45

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

47 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 48 more pathology C. SP Whiplash Injuries” 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 49 C-1 ring fx Spinal Cord

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

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

52 52 HANGMAN’S FX C.SP The hangman´s fracture is located in the pedicles of C2, with C2 displacing anteriorly on C3

53 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 54 Jefferson fracture lateral displacement of lateral masses of C1 bilaterally (white lines).

55 55

56 56 Image Critique (Elsevier)

57 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 angle Shoulders are not rotated away from the cervicothoracic region, preventing clear image of the spine.

58 58 Excessive flexion excessive extension of neck

59 59

60 60 excessive extension of neck excessive flexion of neck

61 61

62 62 Some rotation & Tilt

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

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

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

66 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 67 Some studies of spinal trauma have recorded a missed injury rate as high as 33%.

68 68 C1 c2 sublux c4 wedge fx

69 69 Fracture of the pedicles with dislocation of C5 and C6. Note superior portion of C7 shown on this image.

70 70 Dislocation of the C3 and C4 articular processes Note that C7 is not well demonstrated

71 71


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