Download presentation
1
CERVICAL SPINE RTEC 124 WEEK 6 Rev 2010
4
Review the anatomy
6
Direction of cervical zygapophyseal joints
seen in OBLIQUE seen in LATERAL position
7
INTERVERTEBRAL FOREAMEN
AP = SIDE UP PA = SIDE DOWN
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”, 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
Done supine or upright
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
13
Done supine or upright
17
LATERAL C.SP
19
Some rotation ((zygo & pillars not s/i)
& TILT
21
C.SP OBLIQUES
24
With head in true lateral –
Look at the mandible position
25
With head in oblique – Look at the mandible position
26
“SWIMMERS FOR C.SP TWINNING & PAWLOW METHODS
28
Name of the position ?
29
C/R @ C7- T1 PERP OR ANGLED 5 CAUD
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
MML ┴ to IR MML // with CR Alternate Positioning Fuchs vs Judd
Demonstrates? MML ┴ to IR MML // with CR
33
AP oblique atlanto-occipital joint.
35
BEST SEEN
37
SPINAL INJURY PT an overview : this will be covered in more detail in the TRAUMA lecture
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
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
X-TABLE LATERALS AKA ‘DORSAL DECUBITUS” CERVICAL SPINE
Can be done with or without a grid With Comp Rad probably need a grid
41
X-table Lateral C. SP
42
Peds pt with comp Dis loc C-2 C-3
Pt died on table
43
For Odontoid in C collar
44
X-table lat –”Swimmers” Note: Mrs
X-table lat –”Swimmers” Note: Mrs. Charman’s tip : Place forearm on forehead to prevent superimposition of humerus + c.sp
46
Alternate “Trauma Views”
OBLIQUE – TRAUMA C.SP
47
Pathology Terms Neck pain HANGMANS FX Many causes including
Trauma MVA, sports, falls degenerative disease Infections Neoplasms congenital variations, inflammatory arthritis psychic tension Etc……… HANGMANS FX JEFFERSON FX CLAY SHOVELER’S FX SUBLUXATION COMPRESSION FX REVIEW PG # 388 Merrills
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
Spinal Cord C-1 ring fx
50
.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
52
HANGMAN’S FX C.SP The hangman´s fracture is located in the pedicles of C2, with C2 displacing anteriorly on C3
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
Jefferson fracture lateral displacement of lateral masses of C1 bilaterally (white lines).
56
Image Critique (Elsevier)
57
Image Critique (Elsevier)
Shoulders are not rotated away from the cervicothoracic region, preventing clear image of the spine. There are two possible reasons: excessive rotation of the upper torso beyond a 45° oblique position or incorrect or inadequate CR angle angle
58
Excessive flexion excessive extension of neck
60
excessive flexion of neck
excessive extension of neck
62
Some rotation & Tilt
63
C 7 not seen Use weights (5-10) lbs if possible Expose on expiration
64
Not enough rotation to 45º
Position? TOO much rotation (look at spinous Process) Looks like “AP”
65
Upper OK – lower - too much rotation of body (Done PA ) CR < wrong way
66
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 ↓
67
Some studies of spinal trauma have recorded a missed injury rate as high as 33%.
68
C1 c2 sublux c4 wedge fx
69
Fracture of the pedicles with dislocation of C5 and C6
Fracture of the pedicles with dislocation of C5 and C6. Note superior portion of C7 shown on this image.
70
Dislocation of the C3 and C4 articular processes
Note that C7 is not well demonstrated
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.