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Practical approach to Cervical Spine Trauma

Practical approach to Cervical Spine Trauma. Dr. Donald E. Olofsson. Acknowledgments. A sincere and special thanks to Dr. Tudor Hughes for his inspiration, outstanding teaching and for his images. Without Tudors help. A box of crayons and a few ideas. Hmmm. We put our heads together.

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Practical approach to Cervical Spine Trauma

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  1. Practical approach to Cervical Spine Trauma • Dr. Donald E. Olofsson

  2. Acknowledgments • A sincere and special thanks to Dr. Tudor Hughes for his inspiration, outstanding teaching and for his images.

  3. Without Tudors help • A box of crayons and a few ideas. Hmmm...

  4. We put our heads together.

  5. This was my best attempt.

  6. With Tudors help. • Very professional.

  7. Overview

  8. Overview • Readout • Anatomy • Technique • Trauma

  9. Overview • The scout view and reconstruction. • Plain films: In and out of collar, flexion and Extension views • CT, series included and reconstructions • Stable vs. unstable • A few classifications

  10. Overview • Reading Algorithm

  11. Reading Algorithm • The scout view. • Soft tissues including brain,tubes and lines. • Bony alignment. • Facet joint alignment. • Look at common sites of fractures and the second fracture. • Other bones, and maximal STS.

  12. The scout view (The hidden view) • Also known at the Naval Hospital as…The staff view, the overview, the First view. • Almost always included…Not always pushed to PACS and not always viewed.

  13. The scout view • Within voice recognition (AGFA Talk) template you can add. [The scout view is unremarkable.]

  14. There may be a free lateral view.

  15. A nice frontal view.

  16. You may find the cause of pain.

  17. Scout view with humeral fractures

  18. These were known fractures.

  19. Scout view unremarkable

  20. You can window and level the scout. The Scout View You will have to select the window/level from a different image.

  21. You can enlarge the scout. The Scout View

  22. Discover unexpected findings. The Scout View Pneumothorax

  23. CXR several hours prior to CT with Chest tube. The Scout View • The lung was up prior to CT. The tube was either clamped for CT or not functioning. • No AM CXR ordered. • Ward team notified. • Note: all of these scout views are from the same morning.

  24. Pulling the scout view on AGFA • Including the statement [The scout view is unremarkable.] in your template may help remembering to do this. • You are responsible for the image anyway so the statement will not hurt you, and it may serve as a reminder to pull and look at the image.

  25. What the scout view can show. • Fractures/Dislocations • Tubes and lines • Associated injuries • Pneumothorax • Foreign bodies

  26. Reconstructing the CT images • Bring up the CT. • Reconstruct the thin axial images. • Bring up the sagittal images. • Rotate to create a true axial.

  27. Reconstructing the CT images • Level the axial from the coronal view. • Double click the axial image to enlarge. • Scroll the axial images C1 to about C3. • Rotate off the sagittal for C4. • Scroll • Rotate off the sagittal for C5-T1.

  28. Anatomy

  29. Anatomy • The anatomy of C3-C6 is basically the same. • The anatomy of C1,C2 and C7 are special.

  30. Normal C-SPINEThe Atlas & Axis • C1 the Atlas: • Anterior and posterior arch & Lat Masses, Small transverse process (contains transverse foramen) • C2 the Axis: • Body, lat masses, lamina, spinous process and Ondontoid process (dens).

  31. Craniocervical Ligaments Netter

  32. C3-C6 • Body • Lamina • Spinous Process • Transverse process • Pedicle & Transverse process • Articulating facets

  33. Anatomy

  34. C-Spine AP

  35. Lateral view: Anatomy

  36. Oblique View: Anatomy Greenspan

  37. Oblique View: Anatomy

  38. Technique

  39. Technique - Routine

  40. Lateral view: Technique C7 30M MVA Thought to be paraplegic

  41. Lateral view: Technique C7 C7 C7 C7-T1 Fracture Dislocation 30M MVA Thought to be paraplegic

  42. Technique - Flexion / Extension Open C1 posterior arch

  43. Technique - Flexion / Extension 30F post trauma acute films

  44. Technique - Flexion / Extension 30F post trauma 8d later

  45. Flexion and Extension Extension Peg # hard to see 37M

  46. Flexion and Extension Flexion Peg # hard to see 37M

  47. Technique - CT • Excellent visualization of fractures • Must be optimized • Thin slices 1 - 1.25 - 2mm • Bone and soft tissue algorithm / window • Orthogonal planes • Thin recons • Use workstation • 3D for alignment Bifacet Dislocation

  48. Technique - MRI • Poor visualization of fractures • Good for soft tissue injury • Good for spinal cord injury assessment • Good for spinal cord injury prognosis • Good for root avulsion C7 Romanoff Fracture

  49. C-5 facet fracture not well seen on plain films Technique - CT C5 5

  50. C-5 facet fracture not well seen on plain films Technique - MR C5 Sag T2FS 5

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