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

5. spinal Imaging after trauma - indications
clinical indications
a. spine-region pain
b. neurologic deficit
(1) radicular
(2) cord
c. severe multisystem injuries
d. altered mental status
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
bony - fractures/dislocations
a. X-rays – AP, lateral, open-mouth odontoid
b. CT scan
ligamentous
a. MRI scan
b. flexion – extension lateral x-ray
3. disk injury
b. CT/myelogram

10. cervical: 7 lordotic curve thoracic: 12 lumbar: 5 kyphotic 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 1 2 3 4 5
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

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

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

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)
Types Flexion/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