Lines of Mensuration Continued

• Cervical Spine Lordosis– Depth Measurement (range of 7=17)– Method of Jochuvisen (range 1-9)

• anterior body of atlas• anterior/superior C7• measure C5 to line

– Angle of curve - each disc space– C1-C7 lordosis

Lines of Mensuration Continued

• Prevertebral space maximum– C1 - C5 - 7mm– C5 - C7 - 20mm

• Penning Analysis

COMMON CONDITIONS

• Postural • AP Curves

– Normal - lordosis with dens over anterior/superior corner of C7

– Abnormal - hy[erlordosis, hypolordosis, reversal

Common Conditions Continued

– Hypolordosis/Reversal due to:• trauma• muscle spasm• degenerative joint disease• posterior laminectomy (with decreased or reusal of the

sagittal curve there is a decreased response to corrective decompression

Common Conditions Continued

– Sagittal - curves, scoliosis, tower– Dr. Wittmer study– Pre and post cervical spine molding

• no clear evidence of benefit

Common Conditions Continued

• Degenerative Joint Disease– Spondylosis– Uncovertebral arthrosis– Facet arthrosis– Motion alteration– Compression effects– X-ray often NOT predictive

Common Conditions Continued

• ADI– Child up to 5.0mm– Adult up to 3.0mm– Stress view in flexion/extension– Decreased ADI - arthritis– Increased ADI

TRAUMA with the rupture of the transverse ligament

• Much less common than Den’s fracture• Transverse ligament rupture much greater threat

to life• Guillotime effect - Guillotine• Most common type is Type II Den’s fracture, its

unstable• Type I and Type III is stable• Type I israre, Type III is a close second

INFECTION: INFLAMMATORY

ARTHRITIDE• Rheumatoid arthritis• Psoriasis• Ankylosing spondylitis• Reiter’s

Trauma• Jefferson’s Fracture

– C1 ring fracture (significant neurological deficit or death, which is uncommon

– Decompression– Greater or equal to two fracture locations– Axial load

• Posterior Arch Fracture– most common– 80% will have other cervical spine fracture

Hangman’s Fracture (traumatic spondylolisthesis)

• C2 fracture among most common cervical spine fractures

• 40% of axis fractures are hangman• result from MVA with abrupt deceleration

and/or compression and hyperextension• bilateral pedicle fracture

– 25%