C-Spine Trauma

Front 1

Describe how you analyze the lateral view of the c-spine

Back 1

A=alignment, adequate
can you view the top of T1, are the anterior vertebral line, posterior vertebral line and spinolaminar line lined up
B=Bones
C=cartilage spaces
D=Dens, predental space <3mm, <5mm (kids)
Harris ring in place
S=soft tissue
prevertebral 6mm @C2
22 mm @c7

Front 2

Describe the odontoid view

Back 2

lateral aspects of c1 and c2 should align
medial aspects of should align
Dens should be centered

Front 3

When are flexion/extension views indicated?

Back 3

When all are present:
persistent neck pain or focal tenderness
negative plain films
alert patient
neurologically intact

Front 4

What is pathological subluxation on flexion-extension films?

Back 4

>2mm

Front 5

What are indications for ct?

Back 5

further evaluate fractures or suspected fractures
when plain films are indadequate to see C1-C2, C7-T1

Front 6

What makes up the anterior column?

Back 6

Vertebral bodies
intervertebral discs
ant.long.ligament
post.long.ligament

Front 7

What makes up the posterior column?

Back 7

spinal canal
pedicles
transverse process
facets
laminae
spinal processes
nucal ligament
supraspinous
interspinous
capsular ligament
ligamentum flavum

Front 8

When is spine unstable?

Back 8

When have disruption of both columns

Front 9

What is the mechanical vs. neurological stability?

Back 9

You can have neurological instability even without a fracture in cases such as a ligamentous injury w/o fracture, fracture fragments that threaten cord but no instability to columns, and epidural hematoma

Front 10

What are the injuries seen with fhyperlexion?

Back 10

anterior subluxation (cervical sprain)
bilaeral facet subluxation
wedge fracture
clay shoverler's fracture
flexion tear drop

Front 11

What are the injuries seen with flexion-rotation?

Back 11

unilateral facet dislocation

Front 12

What are the injuries seen with extension?

Back 12

hyperextension dislocation
atlas anterior avulsions
post.arch of atlas
hangman's fracture
laminar fractures
extension tear drops

Front 13

What are the injuries seen with compression?

Back 13

jeffereson fracture (burst fracture)

Front 14

Describe a simple wedge fracture

Back 14

compression of vertebral body
usually stable
loss of height of vertebral body

Front 15

Flexion teardrop fracture

Back 15

Fracture of anterior-inf. vertebral body
common to have ligamentous injury
very unstable

Front 16

Extension tear drop injury

Back 16

ant. long. ligament pulls off piece of vertebral body
ligamentous disruption uncommon
unstable in extension
associated with central cord in elderly

Front 17

Clay Shoveler's fracture

Back 17

flexion injury
avulsion fracture of C7 spinous process
mechanically stable

Front 18

Subluxation injury

Back 18

flexion injury
disruption of post. ligaments, no bony injuries
widening of post. disc space and inerspinous space
usually unstable

Front 19

Unilateral facet dislocation

Back 19

Flexion and rotation
Inf.facet is drawn cranially and roaed about and indront of superior facet
spinous process malalignment on AP view
Post. element ligaments disrupted but stable because facet is locked

Front 20

Bilateral facet dislocation

Back 20

severe flexion
complete disruption of all ligamentous structures at one level
inf.facets flexed cranially and in front of superior facets
very unstable
high association with cord injury

Front 21

Hangman's fracture

Back 21

Hyperextension
bilateral pedicle fractures of C2
prevertebral hematoma common
unstable
often not associated with cord injury

Front 22

Jefferson fracture

Back 22

Verticle compression
C1 shattered
involvement of anterior arch of C1 and disruption of transverse ligament
very unstable
widened predental space
prevertebral hematoma
malalignment of c1 lateral masses on odontoid view

Front 23

Odontoid fractures

Back 23

varied mechanisms
Type I: avulsion of tip of odontoid above transverse ligament, stable
Type II:fx at base of odontoid at or below transverse ligament
C2 subluxes on C1
unstable
Type III: dens and body of C2, if not displaced, stable

Front 24

Describe complete spinal cord lesion

Back 24

loss of all motor and sensory function below level of injuryIf persists for 24 hrs, poor prognosis
any function below level implies incomplete injury and better prognosis

Front 25

What is spinal shock?

Back 25

Transient, conclusive injury to spinal cord

Front 26

What does the absence of the bulbous cavernous reflex imply?

Back 26

Existence and or persistence of spinal shock

Front 27

Central cord syndrome

Back 27

-Forced hyperextension w/buckling of ligamentum flavum causing transient cord compression and microhemorrhage
Upper extremeties worse than lower (upper more central on cord)
Pyramidal and spinothalamic tracts affected
good prognosis

Front 28

Anterior cord syndrome

Back 28

forced flexion resulting in cord injury from:
cord contusion
vert.body compression with retropulsed fragments
thrombosed ant.spinal artery
embolization
Spinothalamic(pain and temp),
corticospinal sometiems affected
post.columns spared (post.,light touch, vibratory sensation)
so so prognosis

Front 29

Brown-Sequard lesion

Back 29

Hemisection of cord
loss of ipsilateral motor and contralateral sensory