spineinjuries脊柱损伤影像学.pptVIP

Cervical Spine Trauma Elda Baptistelli de Carvalho, MD, PGY-3 University of Toronto Objectives Clinical indication for each imaging modality Identify anatomy of cervical spine Approach to C-spine radiography interpretation Classification of spine injuries Who gets radiographs? Midline cervical tenderness Focal neurologic deficits Altered LOC Evidence of intoxication Painful distracting injury Who gets CT? Dangerous mechanisms/high energy mechanisms: -fall from elevation = or 3 feet/5 stairs -axial load to head (diving) -MVC high speed (100 km/h), ejection -motorized recreational vehicles -bicycle collision Who gets MRI? Unexplained neurologic symptoms/signs For visualizing soft tissues, neural elements and unsuspected disk herniation To differentiate cord edema x hemorrhage x infarction To better characterize epidural hematoma Anatomy Approach to C spine radiograph ABC’S -Adequacy Approach to C spine radiograph ABC’S -Adequacy Approach to C spine Radiograph ABC’S -Alignment Approach to C spine Radiography ABC’S - Bones Approach to C spine radiograph ABC’S - Cartilage Approach to C spine radiograph ABC’S -Soft Tissue Rule 2-6 (C2-6 mm) 6-2 (C6-2 cm) Case 1 Case 1 Mechanism of Fractures Hyperflexion Hyperextension Axial Compression Classification Classification Hyperflexion Case 2 Clay shoveler fracture Stable fracture Hyperflexion ( shoveling snow) Sudden exertion of muscular attachment Avulsion # of spinous process of C7C6T1 Rule out extension to lamina, facet #, unilateral jump facet Case 3 Unilateral Facet Dislocation Hyperflexion + rotation Superior facet slides over inferior facet and becomes locked Anterior subluxation of superior vertebral body –25% AP diameter Stable injury 30% with associated neurologic deficit MRI: disk extrusion leading to cord compression Case 4 Bilateral Facet Dislocation Extreme hyperflexion Anterior dislocation of articular masses (disruption of poste