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C-Spine trauma

65% of all spine injuries, 40% cord injury, NEXUS criteria, may be cleared w/o imaging
ACR Appropriateness criteria, Swimmers view

Adequacy: have to see the top of T1
Alignment: Anterior vertebral line, posterior, spinolaminar line, posterior spinous line, predental space (3mm, kids 4-5mm - RA, AS, DS, trauma)
Bones: Jefferson fx
S: ST swelling above C4 < 50% width of vertebral body; below C4 width of vertebral body

Anatomy: facet joints, lamina, spinous process, pars interarticularis - lateral mass, pedicle, transverse foramen (vertebral artery),
Spinal canal: posterior vertebral body to spinolaminar line

Classifications of C-spine injuries
Stable: vertebral compression > 25%, anterolisthesis, widened or narrowed disc space, widened interspinous spaces, widened apophyseal
3 columns: anterior, middle, posterior

Flexion injuries:
Wedge compression fx: MRI T2 w/ fat sat, anterior wedging > 3mm
Flexion teardrop: C6, C7, ligamentous injury, unstable, permanent quadruplegia, vertebral artery injury
Bilateral facet locks, dislocation: >50% anterior dislocation, all ligaments injured: anterior, posterior, flavum, interspinous, ..., unstable
Clay shoveler fx: C7 spinous process fx; stable injury
Unilateral facet dislocation: < 50% of anterior dislocation, simultaneous flexion and rotation, stable, perched, bow-ties, bat-wing

Hangman fx: pars interarticularis fx of C2; hyperextension, chin on dashboard w/o seat belt
Extension teardrop: stable, hyperextension,

Jefferson fx: lateral masses of C1 lateral displacement > 2mm, transverse ligament tears,
Burst fx: C3-C7, fx fragments into canal (retropulsion), stable unless >25% of compression

Atlanto-Occipital dislocation: Down Sy; distance from basion (tip of clivus) to the posterior ring of C1, opisthion, unstable
Dens fx: type 1 - high (unstable), type 2 neck , type 3 below neck
C1 fx other than Jefferson: rare, isolated

congenital nonunion, Mach line (looks like type 2), os odontoideum,
degenerative changes, DISH, AS