RADIOGRAPH OF VERTEBRAE

dr. Sianny Suryawati, Sp.Rad Departemen Radiologi FK UWKS

The lateral view is the most useful view. Approximately 85-90% of spinal injuries are evident on this view.

SYSTEMATIC APPROACH:

Check alignment by following 4 contour lines:

Anterior

contour line connects the anterior margins of the vertebrae. Posterior contour line connects the posterior aspect of the vertebrae. Spinolaminar contour line connects the bases of the spinous processes. Spinous process contour line

Young children may have pseudosubluxation in upper cervical spine.

Prevertebral space:

at C2 no more than 7 mm. at C3 and C4 no more than 5 mm. at C6 it is wider due to esophagus and cricopharyngeal muscle, but should not exceed 22 mm in adults or 14 mm in children younger than 15 years. In children younger than 24 months there can be physiologic widening of the prevertebral space during forcefull expiration (i.e.crying).

Widening of the space between spinous processes suggests ligamentous disruption.

THE NEXUS CRITERIA STATE THAT A PATIENT WITH SUSPECTED C-SPINE INJURY CAN BE CLEARED PROVIDING THE FOLLOWING

STABILITY

Three column theory of Denis

THREE COLUMN THEORY OF DENIS

Used to predict the soft tissue injury from bone injury. Spinal stability is dependent on at least two intact columns. When two of the three columns are disrupted, it will allow abnormal segmental motion, i.e. instability.

Criteria to predict soft-tissue injury from bony injury are:

Angulation

greater than 20 degrees. Translation of 3.5 mm or more.

Images of a 31 year old male. He was working on a roof, fell approximately 5 meters landing on his feet. He complained of pain in left lower extremity and lower back.

CT, sagittal reconstructions : the posterior part of the vertebral body is of normal height, but there is some involvement of the posterior part of the vertebral body.

CT : coronal and axial slices

The MR images show bone marrow edema in the involved vertebral body, but no additional soft tissue injury.

CHANCE FRACTURE

Three column injury with a horizontal orientation of the fracture.

CT : sagittal reconstruction

CT : coronal reconstruction

SPONDYLOLISTHESIS

Herniation of the nucleus pulposus: Schmorls node Frontal view of the lumbar spire reveals narrowed disk space between L2 and L3 with irregular margins Lateral view shows the narrow disk space and the large AP diameter of L3. The anterior defect (arrow) is the site where the nucleus pulposus has herniated and disrupted the ring apophysis of the vertebral body

SACROCOCCYGEAL ANGULATION POST TRAUMA

SCOLIOSIS : NEUTRAL + LATERAL BENDINGS

ANY QUESTIONS ?