Alignment

Key Things to Identify

• Predental space –should be 3mm or less

• Disc spaces should be the equal and symmetric

• Prevertebral soft tissue

AP View• The height of the cervical vertebral bodies should be approximately equal

• The height of each joint space should be roughly equal at all levels.

• Spinous process should be in midline and in good alignment.

Odontoid View• The distance from the

dens to the lateral masses of C1 should be equal bilaterally.

• Secondary to hyperextension

• Best seen on lateral view

• Signs:

– Prevertebral soft tissue swelling

– Avulsion of anterior inferior corner of C2

– Anterior dislocation of the C2 vertebral body.

• Fracture of the odontoid (dens) of C2

• 3 categories, I-III

• Best seen on the lateral view

• Signs:

I – Fx through superior portion of dens

II – Fx through the base of the dens

III – Fx that extends into the body of C2

Type II

Type III

• Anterior compression fracture of the vertebral body

which results from a severe flexion injury.

• Signs:

o Prevertebral swelling

o Teardrop fragment from anterior vertebral body

avulsion fracture.

o Posterior vertebral body subluxation into the

spinal canal.

Spinal cord compression from vertebral body

displacement.

Fracture of the spinous process.

• Fracture of C3-C7 that results from axial compression.

• CT is required for all patients to evaluate extent of injury.

• Fracture of a spinous process C6-T1

• Signs:

– Spinous process fracture on lateral view.

– Ghost sign on AP view (i.e. double spinousprocess of C6 or C7 resulting from displaced fractured spinous process).

• Compression fracture resulting from flexion.

• Signs:

– Buckled anterior cortex.

– Loss of height of anterior vertebral body.

– Anterosuperior fracture of vertebral body.

Thoracic: AP, lateral, swimmer’s views

Lumbar: AP, lateral

Thoracic and Lumbar Spine

Trauma

Thoracic and Lumbar Spine

Trauma

Thoracic and Lumbar Spine

Trauma

Thoracic and Lumbar Spine

Trauma

Thoracic and Lumbar Spine

Trauma

• Stable: Isolated to body, less than 50% loss of

height, 1 or 2 levels only

• Unstable: Posterior arch involved, or more than

50% loss of height, or more than 2 levels

• Neurologic injury: Uncommon

• Compression fracture of body and transverse posterior arch fracture

• Most common at T10-L2

• Unstable

• Neurologic injury in 15%, abdominal injury in 50% (tear of mesentery, bowel injury): always CT spine AND abdomen

• Mechanism: FLEXION over a lap seat belt

• Marked flexion force

• Frequently at T10-L2

• Very unstable

• Severe cord/cauda equina injury is common

• Compression fracture of body with superior and inferior end plate fractures, posterior arch fracture with laterally displaced pedicles

• Very unstable

• Over 2/3 have cord injury from retropulsed fragments.

• Axial load/flexion combined mechanism