Vertebral Imaging and Cervical Spine Clearance: Up to Back Pain

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there are ____ vertebrae

7 cervical

12 thoracic

5 lumbar

5 sacral (fused)

4 coccyx (fused)

How many of each vertebrae are there?

This cervical spine is very straight. This is a position of comfort for a patient with cervical strain or some type of pathology.

What is going on here?

Anterior

the ___ arch (elements) of the vertebral collumn is made up of the vertebral body and disc. Loads 80% of the weight

Posterior

the ____ arch (elements) of the vertebral column include the pedicle, transverse process, superior and inferior articular processes, lamina, vertebral foramen, and spinous process.

Pedicle

allows for passage of nerve roots, the area between the body and transverse processes.

lamina

thin, plate like area between the spinous and transverse processes.

spinal nerve, vasculature and fat

each neural foramina contains...

L1/L2

the spinal cord ends as the conus medularis at the level of

conus medularis

the spinal cord ends as the ____ at the level of L1/L2

cauda equina

the spinal cord ends as the conus medularis and projects as the ____ to the sacrum.

anterior vertebral line

red line

Posterior vertebral line

brown line

Spinolaminar vertebral line

green line

Odontoid View

Posterior

joints of the spine are lcoated ____ to the vertebral body

Ligamentum flavum

strongest spinal column ligament from the base of the skull to the pelvis. Anterior to and posterior to the lamina. Protects the cord and nerve roots.

Anterior longitudinal ligament

spinal column ligament that runs from the occiput to the sacrum. Anterior vertebral body to annulus fibrosis

Posterior longitudinal ligament

spinal column ligament that runs from the occiput to the sacrum. Posterior vertebral body to annulus fibrosis

Interspinous ligament

spinal column ligament that attaches to ligamentum flavum, which runs into the cord

Supraspinous ligament

spinal column ligament that attaches tip of each spinous process to the next.

Just Review the three lines

Just Review the three lines

flexion and rotation

____ mechanism of injury causes Unifacet Dislocation

30

only ___% of patients with Unifacet Dislocation have neuro deficit.

Unifacet Dislocation

vertebral body subluxes but less than 25% of width of the VB. Inferior artic facet of superior VB locked in front of superior artic facet of the inferior VB, on 1 side.

C4-C5 and C5-C6

most common levels for a unifacet dislocation.

unifacet dislocation

Bilateral facet dislocation

"Locked" facets, "Naked facet sign" on CT. Anterior longitudinal ligament and posterior longitudinal ligament often injured/disrupted. Superior VB subluxes over inferior VB by greater than 50% of width of VB.

lower cervical region

most common region for Bilateral facet dislocation

lamina and vertebral arch

Bilateral facet dislocations are often associated with fractures of the _____

85

___% of patients with bilateral facet dislocation have neuro deficits

less

decompression of cord

If posterior elements fracture in a bilateral facet dislocation there is ____ chance of quadriplegia

bilateral facet dislocation

Jefferson fracture

fracture of the anterior/posterior arches of C1. Usually bilateral (4 fractures), but does not have to be.

Axial

___ load mechanisms is the typical cause of a Jefferson Fracture

Lateral offset of C1 lateral masses

Hallmark sign of Jefferson fracture

no

due to complete decompression of canal

Do neuro deficits typically accompany a Jefferson fracture.

Jefferson fracture

Jefferson fracture

Hangman's fracture

fracture of C2 vertebral body posterior elements separate from anterior VB. VB of C2 subluxes over C3 VB.

Hyperextension/compression

Unrestrained occupant in motor vehicle crash with head into windshield/rearview mirror

Mechanism of Injury for Hangman's fracture

No

due to spinal canal decompression

Is a Hangman's fracture typically accompanied by neuro deficit?

Hangman's fracture

Hangman's fracture

Burst fractures

fracture in which VB ruptures and fragments of bone and likely disc can be retropulsed into canal. Patients could have neuro findings.

C-spine, T-spine, and upper L-spine

most common spinal levels for Burst Fractures

axial load

MOI for Burst Fractues

Yes, patient could have Neuro deficits

Do patients typically have neuro deficits with Burst Fractures?

T12 Burst Fracture

T12 Burst Fracture

Type 1

Odontoid fracture involving the Tip, rare

Type II

odontoid fracture involving the body of the odontoid process, most common

Type III

odontoid fracture in which the body of C2 is involved

Type 3 Odontoid fracture

Type 2 Odontoid Fracture

Type I Odontoid Fracture

Clay-shovler's fracture

oblique fracture of the spinous processes of the lower C-spine.

C6 or C7

most common spinal level for Clay-shoveler's fracture

Hyperflexion

mechanism of injury for Clay-shoveler's fracture

no

Is Clay Shoveler's fracture typically associated with neuro deficits?

Clay-shoveler's fracture

Axial skeleton

spine, pelvis, skull, ribs

most common location for bony mets

posterior VB

more common area for axial mets ebcause of increased blood supply.

anterior VB

osteoporosis more commonly affects the ____

Mets

Compression of Posterior VB is typically ____

osteoporosis

Compression of anterior VB is typically ____.

compression fracture

______ are common due to bony destruction from Mets

osteolytic or osteoblastic

metastatic lesions can be...

osteoblastic

metastatic lesions that are more dense

Prostate

Osteoblastic lesions are related to mets from _____ CA

Osteolytic

metastatic lesions that are less dense

lung

Osteolytic lesions are related to primary Cancer in the ____