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C SPINE Y A Mamoojee

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Importance of Prompt Diagnosis Neck pain > quadriplegia > death Delayed recognition can lead to irreversible s.c injury and permanent neurologic damage.

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INDICATIONS Who needs XR

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NEXUS NO - Alcohol intoxication Focal neuro deficit Midline tenderness GCS 15 Painful distracting injuries

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CANADIAN C SPINE RULES

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CASE DISCUSSION A person arrives by ambulance to ED on a backboard and a cervical collar after an MVA. Speed of 50km/hr No LOC, no other injuries, no midline tenderness, BAL 0.20. Does he need imaging?

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WHAT VIEWS?

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LATERAL AP ODONTOID SWIMMERS FLEXION/EXTENSION?

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ANATOMY OF NECK LIGAMENTS BONES MUSCLES JOINTS

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Most important view Can see 80-90% of injuries Interpretation: A - adequacy A - alignment B - bone C - cartilage D - disc S soft tissue A - Must have a view of C7 T1 A - Use 3 lines 1. anterior vertebral line 2. posterior vertebral line 3. spino laminar line (base of spinous processes) 4 th line can be used ie. Tips of spinous processes

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Check : B - individual vertebrae C - cartilage D - disc S - soft tissue -

Stable but potentially unstable during flexion Mechanism : hyperflexion Disruption of posterior ligament complex, anterior intact Stable loss of normal cervical lordosis anterior displacement of body fanning of interspinous distance Unstable anterior subluxation >4mm assoc. compression fracture >25% of affected body increase or decrease in normal disc space fanning of interspinous distance

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BILATERAL FACET JOINT DISLOCATION Complete anterior dislocation of the vertebral body Mechanism extreme hyperflexion of head and neck without axial compression Unstable very high risk of cord damage Features complete anterior dislocation >50% of vertebral body diameter Disruption of the posterior ligament complex and anterior longitudinal ligament Bow tie appearance of the locked facets.

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CLAY SHOVELLERS FRACTURE Fracture of spinous process C6-T1 Mechanism powerful hyperflexion, usually combined with contraction of paraspinous muscles pulling on spinous processes (e.g. shovelling). Features spinous process fracture on lateral view Ghost sign on AP double spinous process of C6/C7 due to displaced fractured spinous process

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UNILATERAL FACET JOINT DISLOCATION Stable Mechanism simultaneous flexion and rotation Facet joint dislocation and rupture of the apophyseal joint ligaments FEATURES : Anterior dislocation of vertebral body by

BURST FRACTURE Fracture of C3-C7 that results from axial compression Spinal cord injury secondary to displacement of posterior fragments is common. Mechanism Axial compression >25% loss of height of vertebral body Stable Needs CT or MRI

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JEFFERSON FRACTURE Burst type fracture of C1 Lateral displacement of C1 masses Fracture of anterior and posterior arches on both sides quadruple fracture Unstable transverse ligament rupture Soft tissue swelling is marked on Xray

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ATLANTO AXIAL SUBLUXATION Flexion and rotation causes the transverse ligament to rupture Predental space >3.5mm in adults and >5mm in children Unstable

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ODONTOID FRACTURES 3 Types : I Avulsion of tip at alar ligament (stable) II Base of dens (unstable) common, non union is a complication III Involves body of C2 (unstable)

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