The Neck - 2

THE NECK

Cervical C –7 Thoracic Th –12 Lumbar L – 5 (L1-5) Sacral S -5 (fixed vertebræ) Coccygeal C- 4 (fixed vertebræ)

Vertebra Body vertebral foramen vertebralneural arch pedicleslaminæ 7 processesarticular, transverse,spinous

  

   

C2 - Axis

C-spine lateral anatomy

C-spine AP anatomy

C Spine open mouth-dens

Examination of cervical spine .1 Cross - table LATERAL: view vertebral 7 • bodies must be seen lines 5 • C1-2 area • Disk spaces • Cervical •

C - spine initial radiograph after diving into a shallow pool

C1 C2 C3 C4 C5

C - spine initial radiograph after diving into a shallow pool with the shoulders lowered C1

C 7 is not visualized -

C2 C3 C4

Dislocation of C5 on C6

C5 C6

the shoulders must be lowered even more

Spine anatomy Swimmer's view

Examination of cervical spine .1 Cross - table LATERAL: view vertebral 7 • bodies must be seen lines 5 • C1-2 area • Disk spaces • Cervical •

‫‪Examination of cervical spine‬‬ ‫קו ‪ - 1‬רקמות הרכות ‪:‬‬ ‫מספר ממ’ בגובה‬ ‫‪C1-3‬‬ ‫ורוחב של פחות‬ ‫מגוף‬ ‫החוליה בגובה ‪C4-‬‬ ‫‪7‬‬ ‫קו ‪ - 2‬גבול הקדמי של‬ ‫החוליות‬ ‫קו ‪ - 3‬גבול האחורי של‬ ‫גופי החוליות‬

‫‪5‬‬

Examination of cervical spine .1 Cross - table LATERAL: view vertebral 7 • bodies must be seen lines 5 • C1-2 area • Disk spaces • Cervical •

Examination of cervical spine .1 Cross - table LATERAL: view vertebral 7 • bodies must be seen lines 5 • C1-2 area • Disk spaces • Cervical •

C - spine radiograph

• Soft tissue

swelling Anterior gaping

C3

Dislocated de

Examination of cervical spine 2. If LATERAL C - spine view appear normal and if the patient can cooperate FLEXION and EXTENSION views are obtained ) patient makes them without help ! (

C-spine LAT ANATOMY

Flexion

Extension

Examination of cervical spine 3. Anterior view with closed mouth: • lower cervical spine • alignment • oblique fractures

Examination of cervical spine 4. Open-mouth view of dens: • Dens • C1 )inferior and lateral margins ( • C2 )superior and lateral

Examination of cervical spine 5. Oblique views: Neural foramina )C2T1( Articular facets

C spine LAO anatomy

C spine RAO anatomy

C SPINE MRI ANATOMY

C SPINE MRI ANATOMY

Examination of cervical spine 6. Computed tomography: • Narrow slices • Bone window • MPR

C SPINE CT ANATOMY

C SPINE CT ANATOMY

C SPINE CT ANATOMY

C SPINE CT ANATOMY )CT-myelo(

C1 ‫ חוליה‬- atlas ‫שת הקדמית של‬ C2 ‫ חוליה‬- axis ‫ של‬DE C1 ‫ חוליה‬- atlas ‫של‬Lateral ma

subarachnoid spa spinal co C1 ‫ חוליה‬- atlas ‫שת האחורית של‬

C SPINE CT ANATOMY )CT-myelo(

transverse proces C6 ‫ף החוליה‬ foramen of vertebral arter spinal cor lamin

spinous proces

Most common

MAJOR PATHOLOGIC ENTITIES INFECTION:

HEMORRHAGE:

VASCULAR DISEASE:

MAJOR PATHOLOGIC ENTITIES DEMYELINATING DISEASE :

MENINGITIS

OSTEOMYELITIS OF THE C - SPINE

Trauma of Spine • Motor vehicle accident • Falls • Sport injuries

Trauma of Spine Most common: Upper (C1-C2) cervical spine Lower (C5-C7) cervical spine Thoracolumbar junction (T9-L2)

Imaging studies • X-rays • CT -bones fractures • MRI- soft tissues, spinal cord, CSF, neural roots

Radiology of trauma • Always get two radiographs at 90 degrees to each other! • Look for the second fracture!

Trauma of cervical spine

nterior - flexion forces Following hyperextension forces

FRACTURE OF C1 Jefferson’s fracture

FRACTURE OF C1 Jefferson’s fracture

‫שבר של הלסת‬ ‫תחתונה‬

DENS FRACTURE

DENS FRACTURE

DENS FRACTURE

FRACTURE OF C2 Hangman’s fracture

Posterior elements of the C2 fractured and displaced inferiorly

‫‪FRACTURE OF C2‬‬ ‫‪Hangman’s fracture‬‬ ‫שבר של אלמנטים‬ ‫אחוריים‬ ‫ותזוזה של ‪ C2‬קדימה‬ ‫לעומת ‪C3‬‬

Teardrop fracture Disruption of posterior ligaments and anterior compression of a vertebral body

TRAUMA SEVERE BURST FRACTURE WITH POSTERIOR DISLOCATION OF C5 BODY

COMPRESSED FRACTURE OF C6 BODY

Dislocated den

Unstable cervical spine fractures

Anatomical Considerations

Clinicians use the following triangles to navigate neck anatomy

Anatomical Considerations

Salivary Glands Parotid Gland    Submandibular Gland    Sublingual Glands  Minor Salivary Glands

C SPINE CT ANATOMY

CERVICAL ,,MAP,,

USES OF THYROID U S

CONGENITAL THYROID ABNORMALITYS

NODULAR THYROID DISEASE

              PAPILLARY               FOLLICULAR              MEDULLARY              ANAPLASTIC

DIFFUSE THYROID DISEASE ACUTE SUPPURATIVE THYROIDITIS SUBACUTE THYROIDITIS HASHIMOTO (CHRONIC LIMPHATIC) GRAVES’ DISEASE DIFFUSE GOITER

HASHIMOTO THYROIDITIS

MULTINODULAR GOITER

DIFFUSE GOITER

ADENOMA

BENIGN CALCIFICATION

COARSE PERIFERAL

EGG-SHELL

MEDULLARY CA HORMON  CALCITONIN

 FAMILAL COMPONENT OF MEN 2

MICROCALCIFICATION

MALIGNANT FROM BENIGN LESIONS

FNA

Lymph nodes

Thank you