Cervical SpineCervical Spine

Presented by M.A. Kaeser, DCPresented by M.A. Kaeser, DCSpring 2009Spring 2009

Radiographic AnatomyRadiographic Anatomy APOMAPOM

• DensDens• C1 Lateral massesC1 Lateral masses• C1 Posterior archC1 Posterior arch• C1 Anterior archC1 Anterior arch• C1 TPsC1 TPs• Atlanto-occipital jointAtlanto-occipital joint• Mastoid air cellsMastoid air cells• C2 spinous processC2 spinous process• C2 transverse foramenC2 transverse foramen• MandibleMandible

Radiographic AnatomyRadiographic Anatomy Lateral viewLateral view

C1 posterior tubercleC1 posterior tubercleC1 posterior archC1 posterior archC1 lateral massC1 lateral massDensDensC2-C7 bodiesC2-C7 bodiesIVDsIVDsArticular pillarsArticular pillarsFacetsFacetsLaminaeLaminaeSPsSPsSpinolaminar lineSpinolaminar lineTPsTPsSoft tissue space (PLT)Soft tissue space (PLT)Thyroid cartilage and larynxThyroid cartilage and larynxHyoid boneHyoid boneAngle of mandibleAngle of mandibleMastoid air cellsMastoid air cells

Radiographic AnatomyRadiographic 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 DiscLevel of C5/6 Disc 1 = SCM1 = SCM 2 = CCA2 = CCA 3 = Thyroid cartilage3 = Thyroid cartilage 4 = Laryngopharynx4 = Laryngopharynx 5 = Piriform recess5 = Piriform recess 6 = Trapezius6 = Trapezius 7 = SP7 = SP 8 = TP8 = TP 9 = C5/6 disc9 = C5/6 disc 10 = Vertebral a.10 = Vertebral a.

Level of C4Level of C4 1 = vertebral artery1 = vertebral artery 2 = mandible2 = mandible 3 = hyoid bone3 = hyoid bone 4 = laryngeal space4 = laryngeal space 5 = ICA5 = ICA 6 = IJV6 = IJV 7 = body C47 = body C4 8 = Spine8 = Spine 9 = Lamina9 = Lamina 10 = SCM10 = SCM

Radiographic AnatomyRadiographic Anatomy APLCAPLC

• SPsSPs• LaminaeLaminae• PediclesPedicles• TPsTPs• Articular pillarArticular pillar• Uncovertebral jointsUncovertebral joints• Costotransverse jointCostotransverse joint• TracheaTrachea• IVFsIVFs• Lung apicesLung apices

http://www.e-radiography.net/technique/spine/spine-

Specific ProblemsSpecific Problems DislocationsDislocations

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

Atlantooccipital DislocationAtlantooccipital Dislocation Caused by complex injuryCaused by complex injury Usually causes deathUsually causes death Causes an increase in Causes an increase in

prevertebral soft tissue widthprevertebral soft tissue width

Facet Joint DislocationFacet Joint Dislocation Three typesThree types

• Subluxed facets, perched facets, locked facetsSubluxed facets, perched facets, locked facets Best seen on lateral viewBest seen on lateral view Step deformity, >3 mmStep deformity, >3 mm Occur secondary to hyperflexion Occur secondary to hyperflexion Disruption of ALL, IVD and Disruption of ALL, IVD and

posterior ligamentsposterior ligaments

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

FracturesFractures UnstableUnstable

• Flexion TeardropFlexion Teardrop• Hangman’s Hangman’s • Hyperextension fracture dislocationHyperextension fracture dislocation• BurstBurst• Jefferson’sJefferson’s• OdontoidOdontoid

StableStable• Clay Shoveler’sClay Shoveler’s• WedgeWedge• Extension TeardropExtension Teardrop

Unstable FractureUnstable Fracture Flexion Teardrop Flexion Teardrop

• Extremely unstableExtremely unstable• Posterior displacement Posterior displacement

of the vertebral bodyof the vertebral bodyDisruption of all ligaments Disruption of all ligaments and IVDand IVDOften results in anteriorOften results in anteriorspinal cord compressionspinal 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 FractureUnstable Fracture Hangman’sHangman’s

• Bilateral C2 pedicle fractureBilateral C2 pedicle fracture• MVAs or hangingsMVAs or hangings• Anterior displacement Anterior displacement

of the anterior part of C2of the anterior part of C2

http://www.spineuniverse.com/displaygraphic.php/4095/shaffrey_16yocervicaltrauma_fig3b-99.jpg

Unstable FractureUnstable Fracture Hyperextension fracture dislocationHyperextension fracture dislocation

http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg15.jpg

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

Unstable FractureUnstable Fracture Burst FractureBurst Fracture

• Axial injuryAxial injury• Loss of anterior Loss of anterior

and posterior bodyand posterior bodyheightheight

Bony fragments may Bony fragments may push on the spinal push on the spinal CordCordM/C in mid C/SM/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 FractureUnstable Fracture Jefferson’s Jefferson’s

• At least two At least two fractures of C1fractures of C1

• Secondary to an Secondary to an axial injuryaxial injury

• DivingDiving• Heavy object 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 FractureUnstable Fracture Odontoid FracturesOdontoid Fractures

• Type 1Type 1• Type 2 – most unstableType 2 – most unstable• Type 3Type 3

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Type IType I

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Type IIType II

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Type IIIType III

http://www.radiologyassistant.nl/images/4911d96ff25dbdens5.jpg

Stable FractureStable Fracture Clay Shoveler’sClay Shoveler’s

• Secondary to a flexion injurySecondary to a flexion injury• Avulsion of a piece of SPAvulsion of a piece of SP• M/C in lower C/SM/C in lower C/S

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

Stable FractureStable Fracture WedgeWedge

• Flexion injuryFlexion injury• Compression of Compression of

anterior portionanterior portionof vertebral bodyof vertebral body

http://faculty.washington.edu/alexbert/MEDEX/Winter/ch264fg6.jpg

Stable FractureStable Fracture Extension TeardropExtension Teardrop

• Avulsion of a piece of the Avulsion of a piece of the anteroinferior portion anteroinferior portion of a vertebraof a vertebra

• Often occurs at C2Often occurs at C2

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