Radiology Rounds: Neck Pain After Trauma

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Information about Radiology Rounds: Neck Pain After Trauma

Published on June 6, 2008

Author: radrounds

Source: slideshare.net

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Radiology Rounds: Neck Pain After Trauma

Neck pain after trauma Laura Avery, MD Massachusetts General Hospital Harvard Medical School Boston, MA, USA

 

What is wrong? Did you look at your lines? Which lines you ask? anterior spinal line posterior spinal line spinolaminar line

Did you look at your lines?

Which lines you ask?

anterior spinal line

posterior spinal line

spinolaminar line

Anterior listhesis Of C2 on C3 Posterior displacement of Posterior elements of C2, Note disruption of spinolaminar line Spinolaminar line

What type of fracture are you concerned about?

 

pars interarticularis Superior articular facet Of C2 Inferior articular facet of C2

 

 

 

 

 

 

 

Hangman's frx / Traumatic Spondylolisthesis of the Axis frx of pars interarticularis of C2 & disruption of C2-C3 junction     - type of traumatic spondylolisthesis - "Hangman's frx"     - term "hangman's fracture" is not accurate for the majority of cases, because mechanism of injury for clinically encountered frxs often lacks large traction force present in judicial hangings;     - in cases in which there is neurologic injury, there will usually be significant horizontal translation w/ accompanying damage to the posterior longitudinal ligament w/ or w/o damage of the C2-C3 interspace;     - mechanism of injury in adults:             - judical lesion: hyperextension and distraction;             - hyperextension w/ vertical compression of posterior column , & translation of C2 and C3;             - forceful extension of already extended neck is most commonly described mech of injury, but other causes include                   flexion of flexed neck & compression of an extended neck;             - a blow on the forehead forcing the neck into extension is a classic mechanism of injury producing fractures thru the pedicles                   of C2 known as traumatic spondyloslisthesis of C2 ;

frx of pars interarticularis of C2 & disruption of C2-C3 junction     - type of traumatic spondylolisthesis - "Hangman's frx"     - term "hangman's fracture" is not accurate for the majority of cases, because mechanism of injury for clinically encountered frxs often lacks large traction force present in judicial hangings;     - in cases in which there is neurologic injury, there will usually be significant horizontal translation w/ accompanying damage to the posterior longitudinal ligament w/ or w/o damage of the C2-C3 interspace;     - mechanism of injury in adults:             - judical lesion: hyperextension and distraction;             - hyperextension w/ vertical compression of posterior column , & translation of C2 and C3;             - forceful extension of already extended neck is most commonly described mech of injury, but other causes include                   flexion of flexed neck & compression of an extended neck;             - a blow on the forehead forcing the neck into extension is a classic mechanism of injury producing fractures thru the pedicles                   of C2 known as traumatic spondyloslisthesis of C2 ;

Schematic lateral view of the cervical spine. Note the odontoid (dens), the predental space and the spinal canal. (A=anterior spinal line; B=posterior spinal line; C=spinolaminar line; D=clivus base line)

C2 Unique vertebral body only one the have pars interarticularis C2 provides rotation at its superior articulation w/ C1 , & limited           flexion, tilt, & rotation at its inferior articulation w/ C3;     - body of C2 is the largest of the cervical vertebrae;     - superior articulations are on the lateral masses;     - superior projection of the odontoid is stabilized to the C1 ring by           transverse and alar ligaments;     - lateral masses of C2 have aperture for accepting transversing           vertebral artery;     - axis is transverse vertebra w/ its superior articular facets located           anterior and its inferior facets located posterior;     - isthmus (the pedicles) between these joints is prone to frx;     - prominent spinous process of C2 is palpable beneath of occiput;

C2 provides rotation at its superior articulation w/ C1 , & limited           flexion, tilt, & rotation at its inferior articulation w/ C3;     - body of C2 is the largest of the cervical vertebrae;     - superior articulations are on the lateral masses;     - superior projection of the odontoid is stabilized to the C1 ring by           transverse and alar ligaments;     - lateral masses of C2 have aperture for accepting transversing           vertebral artery;     - axis is transverse vertebra w/ its superior articular facets located           anterior and its inferior facets located posterior;     - isthmus (the pedicles) between these joints is prone to frx;     - prominent spinous process of C2 is palpable beneath of occiput;

 

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