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63 Cards in this Set

  • Front
  • Back
What are the 3 rules of 3 of cervical spine

What are the major C-spine fractures
predentate space should be less than 3mm
prevetebral soft tissue at C3 is 3mm
anterior wedging of 3mm or more suggest a compression fracture

jeffersons (burst of C1)
hangmans (pars of C2)
extension teardrop (anterior inferior avulsion)
clay shovelers (spinous process)
perched/locked facets and alantoaxial dislocation (ligament injury)
What are the 3 parallel lines of the c-spine
anterior bodies (anterior long ligament)
posterior bodies (posterior long ligament)
Spinolaminar white line
What is the spinolaminar white line
the junction between the spinous process and the lamina
What is the mechanism of alantoaxial dislocation
What is th relative movement of C1 and C2 in an alantoaxial dislocation
C1 forward on C2
Are neurologic injuries common with alantoaxial dislocations
What measurement is increased in an alantoaxial dislocation

What is the cause of alanto-axial disassociation
predentate space

Forward movement of the atlas on the axis is normally restricted by the transverse ligament
The transverse ligament is the primary restraint against atlantoaxial, anteroposterior movement. Alanto axial disassoication will occur if this ligament is injured
What is the most common fracture of C1
neural arch fracture
What is the mechanism of a neural arch fracture
What is a common pitfall of a neural arch fracture
congenital anomaly
What does the atlas (c-1) and axis (C-2) look like
What part of the atlas (C-1) is fractured in a burst fractue
anterior and posterior arches of the neural arch
What is the mechanism of a burst fracture
compressive force such as diving accident
What is another name for a burst fracture
jefferson fracture
What is the best way to evaluate a burst (jefferson) fracture using plain film
open mouth view
What does an open mouth view look like
What is the most common fracture of C2
hangmans fracture
Describe a hangmans fracture of C2
fracture through pedicles or pars of C2 with anterior slip of C2 on C3 (pedicle and pars are used interchangeable when refering to C2. This is bc the exact anatomy is not agreed on)

This results in anterior subluxation of the anterior vetebral body (dens) of C2

Also there is posterior displacement of the posterior element of C2
What is the MC cause of a hangmans fracture
hyperextension compression (MVA)
(chin on dashboard)
Are hangmans fractures associated with neuroloical defect
no if associated with MVA
What fracture is associated with an hangmans fracture
a teardrop avulsion fracture of the anterior-inferior aspect of C2
What is the MC cause of a dens fracture
hyperextension injuries
What is the movement of C1 and C2 with a dens fracture
forward subluxation of C1 on C2
What are the 3 major types of dens fractures
tip of dens (5%)
base of dens (65%)
sub-dentate (30%)
What is the mc type of dens fracture
base of dens
What are 3 pitfalls to dens fractures
Non-union ossification centers
Non-union of previous fracture
What is a mach line
Mach bands are an optical phenomenon in which dark
and light lines appear at the borders of structures of different radiodensity on radiographs. I
What type of film is a mach line of the base of the dens seen
(plain film)
coronal and the lateral film should be checked to determine if it is truly a fracture
Where is the mach line seen at the base of the dens
where the C1 anterior arch overlaps the bens
What is the mechanism of a C3-C7 burst fractures
axial loading from MVA
Do burst fractures commonly result in comminuted vertical fractures through the vetebral body
What should be carefully looked for in a pt with a burst fracture
fragments that are retropulsed into the spinal canal
Do burst fractures sometimes result in a flexion tear drop fracture
Describe a flexion tear-drop fracture
avulsed anterior/inferior triangular shaped fragment which is displaced anteriorly
Besides a vertically comminuted fracture of the vetebral body and sometimes a flexion tear drop fracture what else occurs to burst fractues of C3-C7
facet joints and interspionous distance widened
What percent of pt with burst fractures of C3-C7 have neurologic deficits
What is the interspinous distance
the distance between the posterior spinous process on lateral films
Do burst fractures result in disc space narrowing
What is the mechanism of a simple compression fracture of the C-spine
flexion type injury
Does anterior wedging of 3mm or more suggest a compression fracture
Which endplate is usually invoved in a compression fracture
superior endplate
What is a clay-shovelers fracture
avulsion fracture of spinous process of C6 or C7
Which cervical level is more common for a clay-shovlers fracture
What is the mechanism of a clay-shovelers fracture
rotation of trunk relative to the neck
Which direction to the inferior facets of the cervical vertebrae face
they face posteriorly while the superior facets face anteriorly
What is the mechanism by which a ligamentous injury to the spinal cord occurs
How does a distraction injury occur
if your head gets stuck and body is being pulled away
What is the opposite of a distraction injury
compression/axial loading
What are the findings on lateral plain film in a pt with a ligamentous injury of the C-spine
disk space is narrower anteriorly
Is there widening of the interspinous distance on lateral film in a ligamentous injury
yes sometimes
Can a ligamentous injury result in widening of a facet joint
yes, typically this occur more posteriory (on lateral film)
What are 2 potential complications of ligamentous injuries
subluxation of the vetebral body or perched/locked facets
What is more posteriorly located; superior or inferior facet
inferior is more posterior
What is the mechanism of a unilateral locked facet
What percent of unilateral locked facets result in a neurologic deficit
What is seen on the lateral view in a pt with unilateral locked facets
some vetebral bodies appear true lateral and other appear oblique
What is the bowtie sign
this is when some bodies appear lateral and some appear appear oblique in unilateral locked facets
What will be seen on frontal film in a pt with unilateral locked facets
the posterior spinous process will not line up
On the lateral view what does the vetebrae with the unilateral locked facet look like
What is damaged in ligamentous injury of the cervical spine
Posterior ligamentous structures involved in flexion injury are
(a) supraspinous ligament (b) interspinous ligament (c) facet joint capsule (d) posterior longitudinal ligament
What percent of the vetbral body will be subluxed in bilateral locked facets
at least 50%
What is both bilateral and unilateral locked facets associated with
a ligamentous injury
What are the majore fractures of the cervical spine
extension teardrop
flexion teardrop
clay shovelers
perched/locked facets