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CT spine - cervical (Cx), thoracic (Tx) or lumbar (Lx)

Interpretation of CT spine

basic concepts

  • 3 Denis spinal columns concept of spinal injury
    • initially was applied to thoracolumbar injuries in 1976 but is applicable to lower cervical injuries as well
    • anterior column
      • anterior 2/3rds of vertebral bodies includes anterior longitudinal ligt (ALL) and anterior annulus
    • middle column
      • posterior 1/3rds of vertebral bodies includes posterior longitudinal ligt (PLL) and posterior annulus
    • posterior column
      • all the rest - posterior bony elements (pedicles, facets, lamina, spinous process) and posterior ligaments including ligamentum flavum
    • injury to 2 contiguous columns suggests instability
    • if there is an anterior fracture, look hard for a middle or posterior injury
  • systematic assessment of images
    • on the lateral:
      • alignment of ALL, PLL, and ligamentum flavum
      • predental space
      • anterior soft tissue diameter 7-2 rule: 7mm at C2, 2cm at C7
      • assess the 3 columns
    • look for C1 Jefferson injuries
    • assess dens
    • assess facet joints
  • blunt cerebrovascular injury
    • signs and symptoms
      • arterial haemorrhage
      • cervical bruit in patient < 50 yrs age
      • expanding cervical haematoma
      • focal neurologic deficit
      • neurologic exam incongruous with CT brain findings
      • stroke on secondary CT brain
    • risk factors indicating need for CT angiography
      • high energy trasfer mechanism with:
        • Le Fort fracture type 2 or 3
        • base of skull fracture involving carotid canal
        • diffuse axonal injury with GCS < 6
        • cervical spine fractures that involve C1-3 and/or, transverse foramen
        • cervical spine subluxation
        • near hanging with hypoxic ischaemic brain injury
ctspine.txt · Last modified: 2017/07/07 14:46 by

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