颈椎骨折英文

颈椎骨折英文CervicalAnatomyBiomechanicallySpecializedSupportof“large”CranialmassLargerangeofmotionFlexion/extensionAxialrotationUniqueosteologicalcharacteristicsC1-AtlasNobody2articularpillarsFlatarticularsurfaceVertebralarteryforamen2archesAnteriorPosteriorVertebralarterygrooveFunction–TheAtlasC2AnatomyDensEmbriologicalC1bodyBasepoorlyvascularizedOsteoporoticFlatC1-2jointsVertebralarteryforamenaInferomedialtosuperolateralAnatomy–TheAxisAnatomy–TheLigamentsAllowforthewideROMofupperC-spinewhilemaintainingstabilityClassifiedaccordingtolocationwithrespecttovertebralcanalInternal:TectorialmembraneCruciateligament–includingtransverseligamentAlarandapicalligamentsExternalAnteriorandposterioratlanto-occipitalmembranesAnteriorandposterioratlanto-axialmembranesArticularcapsulesandligamentumnuchaeAtlantoAxialAnatomyTectorialMembraneAtlantoAxialAnatomyocciputC1C2TranverseLigamentC1-C2jointAlarLigamentAtlantoAxialAnatomyTransverseLigamentFacetforOccipitalCondyleAtlantoAxialAnatomyVertebralArteryAPPROACHTOC-SPINEINJURIESFollowingtraumaorcomplaintofneckpainObtainlateralAP,andodontoidviewsThelateralviewisonlyadequateifT1canbevisualizedIfthereisanydoubtoffractureorprevertebralswelling,obtainobliqueviewsandconsiderCTAllpatientswithsign/symptomsofcordinjuryrequireMRICervicalViewsAPOdontoidObliquesSwimmer’sViewLATERALVIEW

1.Anteriorvertebralline(anteriormarginofvertebralbodies)2.Posteriorvertebralline(posteriormarginofvertebralbodies)3.Articularpillar(wheresuperiorandinferior

articularprocesses

ofcervicalvertebraehavefusedoneitherorbothsides)4.Spinolaminarline(posteriormarginofspinalcanal)5.Posteriorspinousline(tipsofthespinousprocesses)

C1-C2Predentalspace(distancebetweenposterioraspectofanteriorarchofC1andanterioraspectofodontoidprocess)shouldbe<3mmInadultandless<5mminchildrenOrlessringsignofC2C3-C7Anteriorspinal,posteriorspinalandspinolaminarlines:shouldbesmoothlinesDiscSpacesshouldbeapproximatelysame

anteriornarrowing=flexioninjury.Widening=extensioninjuryFacetjointsshouldbeparallelInterspinousdistanceshoulddecreasefromC3toC7TransverseprocessofC7pointsdownwardandT1UPWARDS

INTERVERTEBRALDISCSPACESFACETJOINTPrevertebralSoftTissueNasopharyngealspace(C1)-10mm(adult)RetropharyngealspaceC2-C4(betweenposteriorpharyngealwallandanteriorborderofvertebrae).

RetrotrachealspaceC5-7(spacebetweenposteriortrachealwallandanteriorinferiorbodyC6)c3-45mmfromvertebralbodyisnormalC4-720mmfromvertebralbodyisnormal5mm22mm10mmAPViewTheheightofthecervicalvertebralbodiesshouldbeapproximatelyequalTheheightofeachjointspaceshouldberoughlyequalatalllevels.Spinousprocessshouldbeinmidlineandingoodalignment.OdontoidViewAnadequatefilmshouldincludetheentireodontoidandthelateralbordersofC1-C2.OccipitalcondylesshouldlineupwiththelateralmassesandsuperiorarticularfacetofC1.

ThedistancefromthedenstothelateralmassesofC1shouldbeequalbilaterally.ThetipsoflateralmassofC1shouldlineupwiththelateralmarginsofthesuperiorarticularfacetofC2.TheodontoidshouldhaveuninterruptedcorticalmarginsblendingwiththebodyofC2.Classificationof

Fracturesofc-spineHyperflexionDistractioncreatestensileforcesinposteriorcolumnCanresultincompressionofbody(anteriorcolumn)MostcommonlyresultsfromMVCandfallsCompressionResultfromaxialloadingCommonlyfromdiving,football,MVAInjurypatterndependsoninitialheadpositionMaycreateburst,wedgeorcompressionfx’sHyperextensionTypesofInjuriesFlexionTeardropFractureC5-6fractureistheresultofacombinationof

flexion

andcompression,mostcommonlyatC5-6Theteardropfragmentcomesfromtheanteroinferioraspectofthevertebralbody.Thelargerposteriorpartofthevertebralbodyisdisplacedbackwardintothespinalcanal.

BestseenonlateralviewItisancompletelyunstablefractureassociatedwithcompletedisruptionofligamentsandanteriorcordsyndromeandquadriplegia70%ofpatientshaveneurologicdeficit.commoninMOTORVECHICLEACCIDENTSigns:Prevertebralswellingassociatedwithanteriorlongitudinalligamenttear.Teardropfragmentfromanteriorvertebralbodyavulsionfracture.Posteriorvertebralbodysubluxationintothespinalcanal.

Spinalcordcompressionfromvertebralbodydisplacement.

Fractureofthespinousprocess.Fractureofthebodyofc5withasmallfragmentanteriorlyFractureofthespinousprocessofC4AcuteangulationatthelevelofC5C6withdisplacementofC5inposteriordirection

WedgefractureCompressionfractureresultingfromflexion.FlexioncompressioninjuryBestseenonlateralviewStableCommoninElderlypatientswith

osteoporosis

or

osteogenesisimperfectaWedgeshapevertebraAntersuperiorbodyfractureHangman’sFractureC-2FxthroughtheparsinterarticularisofC2secondarytohyperextensionBestseenonlateralviewHyperextentioninjuryStablefracture?

Themostcommonscenariowouldbe

frontalmotorvehicle(hittingdashboard)Hangingfalls,divinginjuriescontactsports.NeurologicalinvolvementisrareTYPE1HANGMANFRACTUREThereisahair-linefractureandthereisnodisplacement.C23NORMAL

HANGMANFRACTURETYPE3AnteriordislocationoftheC2vertebralbodyBILATRALC2parsinterarticularisfractures.PrevertebralsofttissueswellingTheCT-imagesconfirmthefracture-linesofthehangman'sfracture.

Theyrunthroughtheparsinterarticularisresultinginatraumaticspondylolysis.

Inthiscasetherewasnoneurologicdeficit,becausethespinalcanaliswidenedatthelevelofthefracture.ExtentionteardropfractureAVULSIONFRACTUREofanterioinferiorcontentoftheaxisresultingfromhyperextentionThisinjuryis

stableinflexionbuthighlyunstableinextension.commonindivingaccidentsItalsomaybeassociatedwiththecentralcordsyndrome.TheCTconfirmsthedisplacedanteroinferiorbonyfragment.

Thisfragmentisatrueavulsion,incontrasttotheflexionteardropfractureinwhichthefragmentisproducedbycompressionoftheanteriorvertebralaspectduetohyperflexion.

JeffersonFractureC-1Fractureiscausedbyacompressivedownwardforce

thatistransmittedevenlythroughtheoccipitalcondylestothesuperiorarticularsurfacesofthelateralmassesofC1.

Thisprocessdisplacesthemasseslaterallyandcausesfracturesoftheanteriorandposteriorarches,alongwithpossibledisruptionofthetransverseligament.SIGNSONXRAY:DisplacementofthelateralmassesofvertebraeC1beyondthemarginsofthebodyofvertebraC2.<2mmbilateralisalwaysabnormal<1-2mmorunilateraldisplacementcanbeduetoheadrotationCTisrequiredtodefinetheextentoffracturedetectingfragmentinspinalcordBURSTFRACTUREC3-7Samemechanismasjeffersonfracturei.eaxialcompressionbutLocatedatc3-7StablefractureTheintervertebraldiscisdrivenintothevertebralbodybelow.PosteriorfragmentsdislocationcommonRequirectforfractureevaluationandbonefragmentinspinalcordOdontoidFractureC2Fractureoftheodontoid(dens)ofC23categories,I-IIIBestseenonopen-mouthodontoidvieworlateralradiographresultfromblunttraumatoheadleadingtocervicalhyperflexionorhyperextensionUnstablefractureOccurinbothelderlyandyoungpatients75%casesarechildrenClassification

TypeI:AvulsionofthetipofthedenswhereitisattachedtoC1.

Thisisararefracture.

Itispotentiallystable.?

TypeII:Throughthebaseofthedens.

Mostcommonfracture.

Alwaysunstableandpoorhealing.

TypeIII:Fracturethroughthebodyoftheaxisandsometimesfacets.

Canbeunstable,buthasabetterprognosisthantypeIIduetobetterhealingofthefracturewhichrunsthroughthemetaphysealbodyofC-2

Type1odontoidfractureTypeIITypeIIICTIMAGEDensDENSTheimagethroughthelateralpartofC2nicelyshows,thatthefracturerunsthroughthebodyofC2,i.e.atypeIIIodontoidfracture.

Theposteriorduraisinanormalposition,buttheanteriorduraisdisplaced(arrow).

ShowingCentrallocationofspinalcordinjuryClayShoveler’sFractureApviewshowghostsignwith2spinousprocesses???Case15yogirlHitbycarwhileridingbikeVSAatsceneVitalsrecoveredbyEMSRoseetal,AmJSurg2023;185(4)Atlanto-OccipitalDislocation2.