Cervical Spine

transverse ligament

C1-C1; holds odontoid process in place like a seatbelt

alar ligaments

C2 dens- occiput; limits upper c rot and lat flexion

tectorial membrane

extension of post longitudinal lig

ossification C1

post= 4yo, ant= 8yo

ossification C2

inf 3-6 yo, sup 12 yo

ossification C3-7

fused at birth, neural arch and spinous processes 2-3 yo

age when vertebral growth ends

25

when does cervical lordosis develop?

head control at 3 mo

when does lumbar lordosis develop?

walking at 1 yo

artery that runs through transverse foramen

vertebral a

standard c radiograph views

AP and lat

trauma radiographs

AP open mouth

neural foramina radiograph

oblique

instability radiograph

lat view w/ max c flexion and extension

AP view is best for

C3- T1 spinous processes and vertebral bodies, 1st rib, clavicle

Lateral view is best for

joint space and 3 lines

AP (open mouth) is best for

C1-C2 and odontoid process

R+L oblique views are best for

intervertebral foramina, uncovertebral, facet joints, pedicles

lat flex and ext stress views are best for

dynamic instability

What shows up white on T1 MRI?

fat: bone marrow in vertebral bodies

What shows up white on T2 MRI?

CSF, IVD

Decision making for imaging of c spine

canadian c spine→ radiographs; severe injury, instability, myelopathy→ CT

Radiograph series for fracture

AP, lat, open mouth; CT if severe

MOI for sprain

MVA (whiplash)

Radiograph series for sprain

AP, lat, lat flex and ext stress views

Radiograph series for IVD herniations

MRI (CT w/ contrast if MRI contraindicated)

Degenerative diseases

DDD, DJD, Foraminal Encroachment, Spondylosis

Best views for DDD

AP and lat; MRI

Best views for DJD

lat and oblique

Best views for foraminal encroachment

oblique

Best views for spondylosis

AP, lat, oblique

Best view for DISH

lat

best view for intervertebral foramen in cervical, thoracic, and lumbar

cervical: 45 oblique

thoracic: lateral

lumbar: lateral

best view for zygopophyseal (facet joints) in cervical, thoracic, lumbar

cervical: lateral

thoracic: oblique 70

lumbar: oblique 45

High Risk according to CCR

alt mental status, mult fx, drowning/ diving accident, significant head/ facial injury, age >65, dangerous MOI, paresthesia in extremities, rigid spinal disease (anky, DISH)

NEXUS

imaging is indicated unless all criteria met: no post midline cspine tenderness, no evidence of intoxication, normal alertness, no focal neuro deficit, no pain distracting injuries

tear drop fracture

hyper flexion injury compresses ant vertebral body

hangmans fracture

bilat pedicles

MOI for fracture of C1 post arch

hyperextension

apical lig

tip of dens to base of occiput

ant and post atlanto occipital membrane

limits excess flexion/ extension

ligamentum nuchae

continuous with supraspinous lig, starts at C7

Special tests for ligament instability

sharps purser and anterior sheer, and alar lig testing

lig flavum

attaches lamina to lamina