Cervical Spine CT
Cervical Spine CT
Search Pattern Assist ?Exam
Purpose
2. Assess for developmental hyposegmentation anomalies
3. Assess for evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD)
4. Assess for evidence of concurrent inflammatory arthropathy disorders (ankylosing spondylitis, RA, JRA, psoriatic)
5. Assess for occipitocervical (or craniocervical) dislocation
6. Assess for malposition of the spinal canal vs the foramen magnum
7. Assess for occipital condylar and occipital calvarial fractures
8. Assess for axial-load fractures (i.e. C1 ring & lateral mass fractures)
9. Assess for dens fracture &/or cruciform ligament tears with malalignment (i.e. X-line abnormality)
10. Assess for vertebral (C1/C2) fractures including cortical/medullary (trabecular)/buckled vertebral body/pedicle/posterior arch and pars intermedia sites)
11. Assess for avulsion fractures (i.e. Type 3 condylar, Type 1 dens, clival tip fractures)
12. Assess for upper cervical injuries of the synovial joint capsules, ALL, PLL, or tectorial membrane; usually requires evidence of a widened space
13. Assess for fracture fragment displacement involving the neural foramen with possible nerve root injury
14. Assess for fracture fragment displacement into the foramen transversaria with possible vertebral artery injury
15. Assess for post styloid space soft tissue injuries with possible ICA vascular injury
Purposes of CT in lower cervical spine injury
1. Assess for levels of restricted motion (operative fusions or acquired autofusions)
2. Assess for developmental hyposegmentation anomalies
3. Assess for evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD)
4. Assess for evidence of concurrent inflammatory arthropathy disorders (ankylosing spondylitis, RA, JRA, psoriatic)
5. Assess for motion segment restriction from operative fusions or Klippel-Feil anomalies
6. Assess for motion segment restriction from chronic degenerative autofusion (vertebral bodies or articular pillars)
7. Assess for motion segment restriction from inflammatory arthropathies with autofusion (ankylosing spondylitis, JRA, RA, psoriatic arthropathy)
8. Assess for motion segment restriction from chronic spondylopathies (PLL traction spurs, DISH, OPLL, CPPD)
9. Assess for offset (listhesis) or malalignment of the cervical vertebral bodies (C3-T2)
10. Assess for offset (listhesis) or malalignment of the cervical articular facet surfaces (C3-T2)
11. Assess for vertebral (C3/T2) fractures including cortical/medullary (trabecular)/buckled vertebral body/pedicle/posterior arch)
12. Assess for avulsion fractures (i.e.distractive vertebral body corner fractures
13. Assess for ligamentous or capsular injuries of synovial joints, ALL, PLL; usually requires evidence of a widened space
14. Assess for articular pillar fractures
15. Assess for hyperflexion complex cervical injuries based on combination of fractures, disc, and ligamentous injuries
16. Assess for hyperextension complex cervical injuries based on combination of fractures, disc, and ligamentous injuries
17. Assess for hyperrotation complex cervical injuries based on combination of fractures, disc, and ligamentous injuries
18. Assess for axial-loaded vertebral body fractures (including lateroflexion compressive fractures)
19. Assess for cervical shear injuries
20. Assess for displaced bone fragments into the spinal canal, spinal root exit zone, or foramen transversaria
21. Assess for associated cervical soft tissue injuries
22. Assess for associated cervical vascular injuries
Prior Study
Findings
Injuries to the upper cervical spine (C2 and above) plus the occipital cervical junction on CT
[Yes/No]
Underlying conditions increasing vulnerability to post traumatic injury
There are levels of restricted motion (hyposegmentation anomalies, operative fusions or acquired autofusions) [Yes/No]
There are abnormal developmental anomalies affecting the C1 ring, C2 pars, and the dens [Yes/No]
There is evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD) [Yes/No]
There is evidence of underlying inflammatory arthropathy possibly increasing or decreasing spine mobility (JRA, RA, psoriatic arthritis, etc.) [Yes/No]
There is underlying bone pathology not related to trauma, but which could have a pathologic fracture [Yes/No]
Ligamentous injuries
There is abnormal widening of dens tip to basion distance (or avulsion fracture of the clival tip) indicating apical ligament disruption [Yes/No]
There is abnormal malalignment of the cervical canal with the foramen magnum [Yes/No]
There is an abnormal X-lines indicating the dens is abnormally displaced [Yes/No]
There is widening of one or both occipital condyles to C1-lateral mass joint space widths indicating occip-cervical injury (2x average width = ligamentous injury) [Yes/No]
There is abnormal widening of the atlanto-axial distance indicating transverse ligament disruption [Yes/No]
There is lilting of dens relative to C2 and/or avulsion fracture off the C1 ring indicating alar ligament disruption [Yes/No]
There is widening of one or both occipital condyles to C1-lateral mass joint space widths and/or facet surface offset indicating occip-cervical injury (2x average width = ligamentous injury) [Yes/No]
There is widening of the width of C1-2 facet spaces indicating capsular injury (2x average width = ligamentous injury) [Yes/No]
There is widening of the width of C2-3 facet spaces consistent with facet capsular injury (2x average=injury) [Yes/No]
Bone fractures and/or other injuries
There is fracture of either occipital condyles; include assessment of an occipital bone fracture extending into the condyle [Yes/No]
There is a fracture of the C1 ring, or there is bilateral translational offset of the lateral masses of C1 relative to C2 (in AP plane) also consistent with a C1 ring fracture (or Jefferson's Fx) even if the fracture line is not discernible [Yes/No]
There is fracture of the dens (3 types) [Yes/No]
There is abnormal cortical rim fracture or medullary buckle or compression in the C2 body indicating fracture, especially at subdental synchondrosis [Yes/No]
Injuries to the lower cervical (C3-T1) spine and cervico-thoracic junction on CT
[Yes/No]
Underlying conditions increasing vulnerability to post traumatic injury
There are levels of restricted motion (hyposegmentation anomalies, operative fusions or acquired autofusions) [Yes/No]
There are abnormal developmental anomalies affecting the C1 ring, C2 pars, and the dens [Yes/No]
There is evidence of chronic arthropathy disorders affecting the spinal canal width (PLL traction spurs, OPLL, DISH, CPPD) [Yes/No]
There is evidence of underlying inflammatory arthropathy possibly increasing or decreasing spine mobility (JRA, RA, psoriatic arthritis, etc.) [Yes/No]
Hyperflexion injuries (below C2): Compressive side anterior to the fulcrum
There is compressive buckle or fracture of the anterior vertebral body beginning at the fulcrum [Yes/No]
There is compressive fracture of one side of the vertebral body indicating a lateroflexion vector [Yes/No]
Hyperflexion injuries (below C2): Distractive side posterior to the fulcrum
There is widening of posterior disc space width (PLL tear) [Yes/No]
There is a posterior vertebral body corner avulsion fracture (Sharpey fiber insertion site) [Yes/No]
There is malalignment & widening of the facet joint(s) [Yes/No]
There is fracture(s) of the articular processes [Yes/No]
There is widening of the interlaminar & interspinous distances (2x average width = ligamentous injury) [Yes/No]
The articular process fracture are displaced into foramen transversarium; r/o vertebral artery injury [Yes/No]
Hyperextension injuries (below C2): Compressive side posterior to the fulcrum
There is no posterior arch compressive fractures (i.e. lamina, pedicle, or spinous processes [Yes/No]
There is a compressive articular body fracture(s) (compression or burst) [Yes/No]
There is malalignment of the facet joint(s) surfaces associated with the articular body compression fracture nor are there any bone fragments displaced into either the spinal canal or neural foramina [Yes/No]
There is abnormal reduced interlaminar/interspinous distances or overlaping of the spinous processes. [Yes/No]
Hyperextension injuries (below C2): Distractive side anterior to the fulcrum
There is widening of anterior disc space width (with likely a ALL tear) [Yes/No]
There is a anterior vertebral body corner avulsion fracture (Sharpey fiber insertion site bone avulsion with potential ALL tear) [Yes/No]
There is an abnormal interlaminar and/or interspinous distances suggesting ligamentous injury. [Yes/No]
Rotational injuries
There is a spiral or oblique fracture of either the dens alone (type 2 dens fracture) or the dens plus the C2 vertebral body (type 3 dens fracture), which would suggest injury on a rotational basis rather the a hyperextension mechanism. [Yes/No]
There is a spiral type of oblique vertebral body fracture, which may extend into the adjacent pedicle for cervical vertebral bodies C3 and below. Nor is there evidence of long axis splinter fracture of any lamina [Yes/No]
There is unilateral capsular injury for the condylar C1/C2 joint space or the C1-2 joint space [Yes/No]
There is significant change in the degree of spine rotation at one motion segment based on the position of the articular pillars [Yes/No]
There is increased width of one or more unilateral uncovertebral joints to suggest a rotary discal injury [Yes/No]
There is a combination of a unilateral articular pillar injury on the same side as the widened uncovertebral joint [Yes/No]
Axial-loading injuries
There is compression injury to the vertebral bodies with buckling, comminuted fractures or actually burst/crush fractures. [Yes/No]
There is compression injury to the central portion of one or more vertebral end-plates [Yes/No]
There is compressive hyperdensity in the medullary trabecular bone [Yes/No]
There is compression on one side of one or more vertebral bodies or just one of the articular pillars indicating a lateroflexion mechanism [Yes/No]
Shear injuries
There is a single level transsection injury to the spine causing a combination of fractures, disc,/articular capsular ligament tears [Yes/No]
There is underlying spinal fusion predisposing to shear injuries (i.e. ankylosing spondylitis, JRA, long segment spinal operative fusion) [Yes/No]
Additional injury observations
There abnormal translational spinal alignment (anterolisthesis, posterolisthesis, or lateral listhesis) [Yes/No]
There is abnormal single motion segment rotational subluxation, usually related to a unilateral articular pillar fracture with rotary offset and possibly perched or locked facets [Yes/No]
There is focal spinal angulation (focal kyphosis-gibbus deformity) [Yes/No]
There is evidence of injury vectors with more than one mechanism [Yes/No]
There are injuries at more than one level [Yes/No]
The columns of stability exceed more than one, indicating the spine is potentially unstable [Yes/No]
Bone fragments are retropulsed into one or more neural foramina, indicating the nerve root or nerve root sleeve may be at risk [Yes/No]
Bone and/or disc fragments are retropulsed into the spinal canal, indicating the spinal cord is at risk [Yes/No]
Bone and/or disc fragments are retropulsed into the foramen transversaria raising the risk of vertebral arterial injury [Yes/No]
There is swelling in the carotid sheath raising the risk of cartoid arterial injury [Yes/No]
Other
No other significant imaging findings are present.
[Yes/No]