CSpine

• Spinal nerves run through the transverse foramen.
• The alar ligament restrains excessive rotation of the cervical spine.
• The alar ligament keeps the upper cervical spine articulating with the occiput.
• The transverse ligament stabilizes the dens.
• The transverse ligament maintains the articulation between C1 and C2.
• The nuchal ligament prevents excessive flexion and rotation.
• The anterior longitudinal ligament prevents excess extension.
• The basic projections of the cervical spine are an AP view and a lateral view.
• The open-mouth AP, or odontoid view, gives the best view of C1 and C2.
• The lateral view of the cervical spine is best for viewing the cervical disc spaces.
• The lateral view of the cervical spine illustrates three lines.
• The first line is the anterior portion of the vertebral bodies.
• The second line is the posterior border of the vertebral bodies.
• The third line is the spinal laminar line.
• The spinal cord sits between lines two and three.
• The relative spacing between the lines seen on the lateral cervical view should stay the same no matter the position of the head.
• The best views of the IV foramen are seen on anterior oblique views.
• The pedicles are best seen on the oblique views.
• Lateral flexion and extension stress views also demonstrate the three lines of the spinal column.
• Per the NEXUS criteria, the patient needs imaging if there is focal neurologic deficit, midline spinal tenderness, altered level of consciousness, intoxication, or distracting injury.
• Spondylosis is osteophyte formation in response to degenerative disc disease.
• Compression fractures are the result of adjacent vertebrae being forced together.
• Axial compression fractures will result in burst fractures.
• A flexion compressive force will result in a wedge fracture.
• An extension compressive force will compress the articular pillars.
• A Jefferson fracture is a compression fracture through both the anterior and posterior arches of atlas.
• A traumatic C2 spondylolisthesis is a compression fracture of the C2 pedicles leading to a dislocation at C2/3
• Traumatic C2 spondylolisthesis is the result of forceful hyperextension.
• There are three types of odontoid fractures.
• Type one odontoid fractures are avulsion fractures due to alar ligament stress.
• Type two odontoid fractures are fractures at the junction of the dens and body. These are the most difficult to treat.
• Type three odontoid fractures are fractures deep below the junction. These heal the best.
• 20% of cervical fractures are odontoid fractures.
• Wedge fractures most commonly occur at C5-7.
• Teardrop fractures occur when a triangular fragment of bone is separated from the anteroinferior corner of the vertebral body.
• The triangular fragment of a teardrop fracture will avulse if the MOI is hyperextension.
• The triangular fragment of a teardrop fracture will compress after hyperflexion.
• Articular pillar fractures are fractures due to compressive hyperextension forces combined with lateral flexion.
• Articular pillar fractures are most common at C6.
• A clay shoveler's fracture is an avulsion fracture of the spinous process produced by hyperflexion forces or forceful contraction of the trapezius and rhomboid.