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CERVICAL SPINE

CERVICAL SPINE. RTEC 124 WEEK 6 Rev 2010. Review the anatomy. Direction of cervical zygapophyseal joints. seen in OBLIQUE. seen in LATERAL position. INTERVERTEBRAL FOREAMEN AP = SIDE UP PA = SIDE DOWN. ROUTINE “5 views” (arthritis, etc) AP “ODONTOID” AP (axial)

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CERVICAL SPINE

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  1. CERVICAL SPINE RTEC 124 WEEK 6 Rev 2010

  2. Review the anatomy

  3. Direction of cervical zygapophyseal joints seen in OBLIQUE seen in LATERAL position

  4. INTERVERTEBRAL FOREAMEN AP = SIDE UP PA = SIDE DOWN

  5. ROUTINE “5 views” (arthritis, etc) AP “ODONTOID” AP (axial) BOTH OBLIQUES, LATERAL (UPRIGHT) SWIMMERS – LATERAL (if needed) ROUTINE “2view” AP (axial) , AP “ODONTOID”, LATERAL (UPRIGHT) SWIMMERS – LATERAL (if needed) TRAUMA CROSS TABLE LATERAL (minimum) “ CLINICAL “ ROUTINE “LATERAL (UPRIGHT) pt is ↑ ┴ C/R PT is ↑ or ↓ AP “ODONTOID” ┴ < C/R (15 – 20 º) ↑ (AP ) AP (axial) BOTH OBLIQUES, SWIMMERS – LATERAL (if needed) pt is ↑ or ↓ POSITIONING FOR CERVICAL SPINE

  6. Done supine or upright

  7. May be more difficult to do upright - use a sponge on back of head to relax neck muscles May need to use a ┴ or C/R < 5º ↑ To move incisors off dens

  8. Done supine or upright

  9. LATERAL C.SP

  10. Some rotation ((zygo & pillars not s/i) & TILT

  11. C.SP OBLIQUES

  12. With head in true lateral – Look at the mandible position

  13. With head in oblique – Look at the mandible position

  14. “SWIMMERS FOR C.SP TWINNING & PAWLOW METHODS

  15. Name of the position ?

  16. C/R @ C7- T1 PERP OR ANGLED 5 CAUD

  17. Alternate Positioning FLEXION & EXTENSION Purpose? Flexion and extension views should be obtained in awake and cooperative patients to further evaluate for injury. Flexion views will exaggerate the radiographic abnormalities and extension views will reduce them. Anterior subluxation & check for ROM

  18. Alternate Positioning Fuchs vs Judd Demonstrates? MML ┴ to IR MML // with CR

  19. AP oblique atlanto-occipital joint.

  20. BEST SEEN

  21. SPINAL INJURY PTan overview :this will be covered in more detail in the TRAUMA lecture

  22. “TRAUMA SERIES” • SHOULD CONSIST OF 2 “views” /projections • 90º TO EACH OTHER • MOVE C/R AND CASSETTE – • NOT THE PATIENT !!! “TAKE IT AS IT LIES” “DO NOT HARM”

  23. When the patient is a true “trauma” care must be taken not to move the patient At a minimum the AP’s & laterals are done with the C.COLLAR in place Then after CLEARED by the MD – you may proceed (?w/o? collar????? ) May be required to repeat AP & Lat again without collar artifact

  24. X-TABLE LATERALSAKA ‘DORSAL DECUBITUS”CERVICAL SPINE Can be done with or without a grid With Comp Rad probably need a grid

  25. X-table Lateral C. SP

  26. Peds pt with comp Dis loc C-2 C-3 Pt died on table

  27. For Odontoid in C collar

  28. X-table lat –”Swimmers” Note: Mrs. Charman’s tip :Place forearm on forehead to prevent superimposition of humerus + c.sp

  29. Alternate “Trauma Views” OBLIQUE – TRAUMA C.SP

  30. HANGMANS FX JEFFERSON FX CLAY SHOVELER’S FX SUBLUXATION COMPRESSION FX REVIEW PG # 388 Merrills Neck pain Many causes including Trauma MVA, sports, falls degenerative disease Infections Neoplasms congenital variations, inflammatory arthritis psychic tension Etc……… Pathology Terms

  31. Passengers forewarned of an impending rear collision can potentially protect themselves by flexing the neck and tucking the chin against the chest. An extended head potentiates the risk of ligamentous rupture and articular dislocation. Areas of preexisting degenerative disease are most susceptible to injury. radiculopathy- segmental motor or sensory signs associated with a root disorder. (numbness in hands/arms) Tear drop fx from Extreme flexion more pathology C. SP Whiplash Injuries”

  32. C-1 ring fx Spinal Cord

  33. .AVULSION FX c-1 • A fracture involving the entire anterior arch is unstable

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