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Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
Radiology Rounds: Neck Pain After Trauma
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Radiology Rounds: Neck Pain After Trauma

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Radiology Rounds: Neck Pain After Trauma

Radiology Rounds: Neck Pain After Trauma

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    • 1. Neck pain after trauma Laura Avery, MD Massachusetts General Hospital Harvard Medical School Boston, MA, USA
    • 2.  
    • 3. What is wrong?
      • Did you look at your lines?
        • Which lines you ask?
          • anterior spinal line
          • posterior spinal line
          • spinolaminar line
    • 4. Anterior listhesis Of C2 on C3 Posterior displacement of Posterior elements of C2, Note disruption of spinolaminar line Spinolaminar line
    • 5. What type of fracture are you concerned about?
    • 6.  
    • 7. pars interarticularis Superior articular facet Of C2 Inferior articular facet of C2
    • 8.  
    • 9.  
    • 10.  
    • 11.  
    • 12.  
    • 13.  
    • 14.  
    • 15. Hangman's frx / Traumatic Spondylolisthesis of the Axis
      • frx of pars interarticularis of C2 & disruption of C2-C3 junction     - type of traumatic spondylolisthesis - "Hangman's frx"     - term "hangman's fracture" is not accurate for the majority of cases, because mechanism of injury for clinically encountered frxs often lacks large traction force present in judicial hangings;     - in cases in which there is neurologic injury, there will usually be significant horizontal translation w/ accompanying damage to the posterior longitudinal ligament w/ or w/o damage of the C2-C3 interspace;     - mechanism of injury in adults:             - judical lesion: hyperextension and distraction;             - hyperextension w/ vertical compression of posterior column , & translation of C2 and C3;             - forceful extension of already extended neck is most commonly described mech of injury, but other causes include                   flexion of flexed neck & compression of an extended neck;             - a blow on the forehead forcing the neck into extension is a classic mechanism of injury producing fractures thru the pedicles                   of C2 known as traumatic spondyloslisthesis of C2 ;
    • 16. Schematic lateral view of the cervical spine. Note the odontoid (dens), the predental space and the spinal canal. (A=anterior spinal line; B=posterior spinal line; C=spinolaminar line; D=clivus base line)
    • 17. C2 Unique vertebral body only one the have pars interarticularis
      • C2 provides rotation at its superior articulation w/ C1 , & limited           flexion, tilt, & rotation at its inferior articulation w/ C3;     - body of C2 is the largest of the cervical vertebrae;     - superior articulations are on the lateral masses;     - superior projection of the odontoid is stabilized to the C1 ring by           transverse and alar ligaments;     - lateral masses of C2 have aperture for accepting transversing           vertebral artery;     - axis is transverse vertebra w/ its superior articular facets located           anterior and its inferior facets located posterior;     - isthmus (the pedicles) between these joints is prone to frx;     - prominent spinous process of C2 is palpable beneath of occiput;
    • 18.  

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