emergency spinal radiological assessment
DESCRIPTION
Emergency Spinal Radiological Assessment. spine injury: location. C. type neurologic sequelae 1. cervical . . . . . . brainstem, cord or root 2. thoracic . . . . . cord or root 3. lumbar . . . . . . conus or root. T. L. cord injury: deficit patterns. - PowerPoint PPT PresentationTRANSCRIPT
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Emergency Spinal
Radiological Assessment
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spine injury: location
type neurologic sequelae
1. cervical . . . . . . brainstem, cord or root
2. thoracic . . . . . cord or root
3. lumbar . . . . . . conus or root
C
T
L
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cord injury: deficit patterns
1. normal (no neurologic injury)
2. incomplete deficit (syndromes)
a. central cordb. anterior cord c. Brown-Sequardd. posterior corde. conus/epiconus
3. complete functional transection
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spine injury: types
1. muscular/ligamentous
a. contusionsb. strainsc. sprainsd. complete ligamentous disruption
2. fractures
+ / - dislocation
stability: 1. stable 2. unstable
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spinal Imaging after trauma - indications
1. clinical indications
a. spine-region pain b. neurologic deficit
(1) radicular(2) cord
c. severe multisystem injuries d. altered mental status
2. clinical rationale
a. prevent cord, root injury (neurologic stability) b. prevent incapacitating deformity and pain
(mechanical instability)
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Which patients need imaging of the cervical spine?
Case 1: mild/moderate trauma patient
– no loss of consciousness– normal mental status (and not intoxicated)– no neck pain or tenderness – no neurologic deficit
no imaging needed
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Which patients need imaging of the cervical spine?
Case 2: mild/moderate trauma patient
– altered mental status (patient is obtunded and/or intoxicated)
– neck pain or tenderness – neurologic symptoms or deficit
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Which patients need imaging of the cervical spine?
Case 3: severe multi-system trauma patient
imaging needed
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spinal Imaging after trauma – imaging tools
1. bony - fractures/dislocations
a. X-rays – AP, lateral, open-mouth odontoid b. CT scan
2. ligamentous
a. MRI scan b. flexion – extension lateral x-ray
3. disk injury
a. MRI scan b. CT/myelogram
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cervical: 7 lordotic curve
thoracic: 12kyphotic curve
lumbar: 5lordotic curve
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spine injury: alignment
1. pre-vertebral fascia
2. anterior marginal line
3. posterior marginal line
4. spino-laminar line
5. posterior spinous line
A. vertebral body width
B. spinal canal diameter
54
32
1
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ligamentous injury without fracture
instability possible even with normal CT; early MRI helpfulstabilize until neck pain resolves, assess competence of
ligaments with flexion/extension X-rays or MRI
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Bilateral facet fracture/dislocation:“jumped” or locked facets
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C1 - Jefferson fracture
axial loadingoften associated with
C2 fracturesassess transverse ligament
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type I
type II
type III
C2 - odontoid fractures/subluxations
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C2 - Hangman’s fracture
hyperextension/axial loading
bilateral C2 pars interarticularis fracture
unstable when:a. >3.5 mm subluxation of
C2 on C3b. >11 degrees angulation
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Atlantoaxial subluxation
• Atlantodental interval (ADI)
• Left: Normal ADI ≤ 3 mm
• Right: C1-2 subluxation
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Denis 3-column model - thoracolumbar spine
one-column injury usually stable
two-column injury usually unstable
three-column injury unstable
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Class A: vertebral body compression
compression fractureAnterior column failureMiddle and posterior columns intactUnstable if >50% compression or
>20 degrees angulation
burst fractureAnterior and middle column failureRetropulsion of bone into canalOften have neurologic deficitUnstable
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Burst fracture
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Class B: distraction (+ flexion/extension)
Types Flexion/distraction (Chance, seat belt injury)Hyperextension
Three-column injury: unstable
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flexion/distractionposterior ligamentous injury
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Class C: three-column injury with rotation
fracture-dislocationshear injury
unstable
neurologic deficit
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fracture-dislocation