Ortho-Preferred

Lateral of C-spine



- See:
     - Flexion and Extension Views:
     - Technique:

   

- Upper Cervical Spine:
    - prevertebral soft tissues
    - occipital-atlanto-axial injury:
           - atlanto-occipital disassociation
                  - C1-C2 interspinous space should not be greater than 10 mm;
           - atlanto-axial impaction (rheumatoid C-spine)
           - atlas (Jefferson frx)
           - axis (odontoid frx / hangman frx)
           - atlantoaxial distance & SAC;
                  - ADI in children (< 10 yrs) < 3.5 mm; (see pediatric C-spine)
                  - ADI in adults < 3 mm;
                        - an anterior shift of C1 on C2 of more than 3-5 mm implies injury to transverse ligament (see atlanto-axial subluxation);
                  - shift > 5 mm implies injury transverse & alar ligaments;
           - SAC:
                  - greater than 18  mm is normal normal;
                  - 15-17 mm - grey zone;
                  - less than 14  mm is consisent w/ cord compression;
    - pseudosubluxation of c spine:

- Sub-Axial Spine - Alignment:
    - posterior cortices: (more important than anterior cortices)
         - anterior or posterior translation of vertebral bodies > 3.5 mm implies instability;
         - w/ less than 25% relative shift of one vertebral body over another consider facet frx;
         - w/ 25% relative shift consider unilateral facet dislocation and w/ 50% shift, consider or bilateral facet dislocation;
    - vertebral body angulation / translation:
         - patterns of instability include:
                - 1.7 mm or greater of disk widening;
                - 3.5 mm of translational displacement;
                - angulation between two adjacent vertebra of 11 deg more than contiguous cervical vertebrae;
                - measurements are made from each inferior endplate;
    - anterior cortices:
         - anterior subluxation
         - minimal compression frx of anterior vertebral bodies;
         - tear drop sign: bone chip off antero-inferior aspect;
                - may indicate displacement of disc or posterior fragment of vertebral body into spinal canal & cord injury;
    - spinolaminar line (dorsum of lateral masses) (see oblique view);
         - facet joint widening;
         - rotation of the facets on lateral view;
         - parallel articular process facets;
    - spinous process angulation:
         - C1-C2 interspinous space should not be greater than 10 mm;
         - widening is present when the distance is more than 1.5 times the inter-spinous distance of adjacent spinal segments;
         - fanning implies middle column disrupton



Biomechanical analysis of clinical stability in the cervical spine.  

Neurapraxia of the cervical spinal cord with transient quadriplegia.  



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 4:21 pm