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Download Spinal Imaging - Wellington ICU
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Spinal Imaging 21/5/11 Diagnostic Imaging in Critical Care - CT is the best way to image the spine for bony injuries (will miss 6% of discoligamentous injuries) - if suspected soft tissue or spinal cord injury -> patient requires an MRI CHECK LIST Sagittal images - space between anterior arch of C1 and peg (< 3mm in adults, < 5mm in children) posterior cortex of C1 anterior cortex of peg spinolaminar line of C1-C3 anterior and posterior spinolaminar lines bodies height and alignment facets aligned no subluxation or widening no prevertebral swelling discs intact no soft tissue swelling Axial images - space between arch and peg < 3mm no significant rotation (< 15 degrees OK) no soft tissue swelling integrity of ring Coronal images - symmetry of peg and lateral masses facets aligned height of vertebral bodies discs and facet joints aligned PATHOLOGIES Bilateral facet joint dislocation - AP: narrowed disc space - lateral: anterior and posterior vertebral body lines and spinolaminar lines disrupted > 50%, angulation - surgical emergency: requires urgent traction or immediate open reduction if patient is neurological normal or has a incomplete spinal injury. Jeremy Fernando (2011) Unilateral facet joint dislocation - AP: spinous processes below the dislocation do not align with those above it, interspinous processes widened. - lateral: facet joint dislocation, 25% forward shift - oblique: facet join dislocation better seen - traction can be used but if unsuccessful -> emergency surgery seldom required. Odontoid fractures - I: tip of odontoid - II: junction of dens and body - III: extending into body of C2 Atlanto-occipital subluxation - can be potentially fatal -> injury of craniocervical junction or brain stem I: anterior subluxation II: vertical distraction of atlanto-occipital joint > 2mm III: posterior dislocation Compressive flexion injury - I: blunting of the anterior-superior vertebral margin - II: beak-like appearance to the anterior vertebral body with loss of anterior vertebral height and an oblique contour. - III: fracture extending from the anterior surface of the vertebral body into the disc space. - IV: posterior displacement of the inferoposterior aspect of the vertebral body <3mm. - V: displacement of the vertebrae below is > 3mm Distraction extension injury - I: abnormal widening of the disc space (disruption of the anterior longitudinal ligament and disc) - II: posterior ligaments are disrupted and the cephalad vertebrae are displaced into the spinal canal. Compressive extension injury - damage to vertebral arch but the body of the affected vertebra remains intact. - can be unilateral or bilateral - can involve the pedicle, articular or lamina (or a combination of these) Vertebral compression injury - body fracture (loss of height) retropulsion into the vertebral canal I: central fracture of either the superior of inferior endplate with a ‘cupping deformity’ II: both endplates are involved III: vertebral body fragmented with fragments displaced in multiple directions. Jeremy Fernando (2011) Diffuse idiopathic skeletal hyperostosis (DISH) - anterior extensive ossification along vertebral bodies. - if come with neck pain -> require an MRI as cord is very susceptible given small canal. Chance fracture - flexion-distraction injury widening of the interspinous interval fracture line through the body high incidence of a intra-abdominal injury TRICKS AND TRAPS Congenital anomalies - look for fractures lines -> if lines smooth think congenital problem deficiency in posterior arch of C1 C1 ring symmetry will be maintained odontoideum: dens separated from the body of C2 deficiency of anterior arch of C1 Jeremy Fernando (2011)
