The CERVICALSPINE In The TRAUMA PATIENT 成像在创伤病人颈椎课件.pptVIP

The CERVICAL SPINE Imaging the Traumatized Patient MI Zucker, MD A dr Z Lecture …on imaging cervical spine trauma. With much gratitude to Jack Harris, MD. Michael I. Zucker, MD Professor, Dept. of Radiology Faculty, Dept. of Emergency Medicine UCLA Medical Center, David Geffen School of Medicine at UCLA 10,000 spinal cord injuries per year in USA Two-thirds are cervical cord. The monetary, physical and emotional losses are great. Our goal: Early detection of injuries to prevent or decrease neurological and mechanical damage to the spinal column. STABILITY: A Word or Two We talk about it, but what is it? A useful definition: An injury is STABLE if putting the spinal column through normal range of motion does not increase neurological or mechanical deficits. Three Column Theory of Denis Spinal column divided into an ANTERIOR, MIDDLE and POSTERIOR column. Injury to one column is stable, two or three are unstable. ANTERIOR COLUMN The anterior longitudinal ligament, anterior 2/3 of the body and disc. MIDDLE COLUMN Posterior longitudinal ligament and posterior 1/3 of body and disc. POSTERIOR COLUMN The posterior osseous arch and ligaments. DOES IT WORK? If two or three columns injured, lesion is unstable: Works well for C3 to T1. Does not work so well for C1-2, so consider most or all injuries here unstable. HOW DO YOU IMAGE THE CERVICAL SPINE? Plain films? CT? MRI? A combination of modalities? Is there a consensus? NO (But we’re headed toward one) My Opinion: O*pin*ion: A belief held with confidence, but not substantiated by proof. Imaging Minor Trauma LATERAL view from skull base through at least the top one-half of T1. May need to supplement with Swimmer’s view. Anterior-posterior (AP) Open Mouth Odontoid (OMO) If patient is not in cervical collar: Adding Oblique views is an option. MINOR TRAUMA: Views Imaging Major Blunt Trauma Cross-table LATERAL plain film in Trauma Suite. CT entire cervical spine. MRI also in selected cases. If you wish, AP, OMO,