1. 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

5. Lines of Mensuration Continued Prevertebral space maximum –C1 - C5 - 7mm –C5 - C7 - 20mm Penning Analysis

9. COMMON CONDITIONS Postural AP Curves –Normal - lordosis with dens over anterior/superior corner of C7 –Abnormal - hy[erlordosis, hypolordosis, reversal

10. 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

11. Common Conditions Continued –Sagittal - curves, scoliosis, tower –Dr. Wittmer study –Pre and post cervical spine molding no clear evidence of benefit

12. Common Conditions Continued Degenerative Joint Disease –Spondylosis –Uncovertebral arthrosis –Facet arthrosis –Motion alteration –Compression effects –X-ray often NOT predictive

13. Common Conditions Continued ADI –Child up to 5.0mm –Adult up to 3.0mm –Stress view in flexion/extension –Decreased ADI - arthritis –Increased ADI

14. 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

15. INFECTION: INFLAMMATORY ARTHRITIDE Rheumatoid arthritis Psoriasis Ankylosing spondylitis Reiter’s

16. 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

17. 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%