ctspine
CT spine - cervical (Cx), thoracic (Tx) or lumbar (Lx)
see also:
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 127.0.0.1