Cervical Spine

Presented by M.A. Kaeser, DC Spring 2009

Radiographic Anatomy

 APOM • Dens • C1 Lateral masses • C1 Posterior arch • C1 Anterior arch • C1 TPs • Atlanto-occipital joint • Mastoid air cells • C2 spinous process • C2 transverse foramen • Mandible

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Radiographic Anatomy

Lateral view

C1 posterior tubercle C1 posterior arch C1 lateral mass Dens C2-C7 bodies IVDs Articular pillars Facets Laminae SPs Spinolaminar line TPs Soft tissue space (PLT) Thyroid cartilage and larynx Hyoid bone Angle of mandible Mastoid air cells

Radiographic Anatomy

http://files.abstractsonline.com/CTRL/12/6/B55/E60/AEE/ 48C/3B7/51F/1B1/ADD/157/40/a1198_19.JPG

http://www.drkassicieh.com/images/MRI-Cervical-spine.jpg

http://www.jbppni.com/content/figures/1749-7221-2-17-1-l.jpg

Level of C5/6 Disc

          1 = SCM 2 = CCA 3 = Thyroid cartilage 4 = Laryngopharynx 5 = Piriform recess 6 = Trapezius 7 = SP 8 = TP 9 = C5/6 disc 10 = Vertebral a.

Level of C4

          1 = vertebral artery 2 = mandible 3 = hyoid bone 4 = laryngeal space 5 = ICA 6 = IJV 7 = body C4 8 = Spine 9 = Lamina 10 = SCM

Radiographic Anatomy

 APLC • SPs • Laminae • Pedicles • TPs • Articular pillar • Uncovertebral joints • Costotransverse joint • Trachea • IVFs • Lung apices http://www.e-radiography.net/technique/spine/spine-

Specific Problems

 Dislocations • Atlantooccipital dislocation (unstable) • Facet joint dislocation (unstable)

Atlantooccipital Dislocation

   Caused by complex injury Usually causes death Causes an increase in prevertebral soft tissue width

Facet Joint Dislocation

     Three types • Subluxed facets, perched facets, locked facets Best seen on lateral view Step deformity, >3 mm Occur secondary to hyperflexion Disruption of ALL, IVD and posterior ligaments

http://sfghed.ucsf.edu/Education/ClinicImages/Jump%20facet %20MRI.jpg

Fractures

  Unstable • Flexion Teardrop • Hangman’s • Hyperextension fracture dislocation • Burst • Jefferson’s • Odontoid Stable • Clay Shoveler’s • Wedge • Extension Teardrop

Unstable Fracture

 Flexion Teardrop • Extremely unstable • Posterior displacement of the vertebral body Disruption of all ligaments and IVD Often results in anterior spinal cord compression http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg8.jpg

http://aser.mypacs.net/aser/repos/aser_repo/viz/full/0/0/2/2137.jpg

Unstable Fracture

 Hangman’s • Bilateral C2 pedicle fracture • MVAs or hangings • Anterior displacement of the anterior part of C2

http://www.spineuniverse.com/displaygraphic.php/4095/shaffrey_ 16yocervicaltrauma_fig3b-99.jpg

Unstable Fracture

 Hyperextension fracture dislocation http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg15.jpg

http://www.radiologyassistant.nl/images/4912b9174ba3fextension-4.jpg

Unstable Fracture

 Burst Fracture • Axial injury • Loss of anterior and posterior body height Bony fragments may push on the spinal Cord M/C in mid C/S http://ajs.sagepub.com/content/32/4/1077/F5/graphic-9.large.jpg

http://www.radiologyassistant.nl/images/thmb_ 49044098aa1abAfbeelding-9.jpg

Unstable Fracture

 Jefferson’s • At least two fractures of C1 • Secondary to an axial injury • • Diving Heavy object http://radiographics.rsnajnls.org/content/vol20/issue3/images/ large/g00mc20l16x.jpeg

http://img.medscape.com/pi/emed/ckb/orthopedic_ surgery/1230552-1264627-384.jpg

Unstable Fracture

 Odontoid Fractures • Type 1 • Type 2 – most unstable • Type 3 http://www.nypemergency.org/moxiepix/b2_3.gif

 Type I http://download.imaging.consult.com/ic/images/ S1933033208734189/gr12a-midi.jpg

 Type II http://www.radiologyassistant.nl/images/4911d5fd8c73bdens1.jpg

 Type III http://www.radiologyassistant.nl/images/4911d96ff25dbdens5.jpg

Stable Fracture

 Clay Shoveler’s • Secondary to a flexion injury • Avulsion of a piece of SP • M/C in lower C/S

http://www.mypacs.net/repos/mpv3_repo/viz/full/57139/2856961.jpg

Stable Fracture

 Wedge • Flexion injury • Compression of anterior portion of vertebral body http://faculty.washington.edu

/alexbert/MEDEX/Winter/ch264fg6.jpg

Stable Fracture

 Extension Teardrop • Avulsion of a piece of the anteroinferior portion of a vertebra • Often occurs at C2 http://www.learningradiology.com/ caseofweek/caseoftheweekpix2008/ cow302lg.jpg

http://download.imaging.consult.com/ic/images/ S1933033207723352/gr1-midi.jpg