Download - Trauma Vertebrae
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TRAUMA VERTEBRAE
dr. Hendro S., Sp.RFK Universitas Wijaya Kusuma
Surabaya
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1. FOTO VERT. CERVICAL1. Proyeksi lateral dalam posisi netral :
- Harus tampak :- Dasar tengkorak- Ketujuh vert. cervicales- Vert. thoracal I
- Teknik :- Bahu pend. ditarik ke bawah
pada saat foto leher- Posisi lateral swimmer’s pada cervical bawah & thoracal atas
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2. Foto odontoid open mouth
3. Proyeksi AP & Oblique
4. CT Scan
Untuk evaluasi lanjut dari foto-polos / daerah yang tak jelas pada posisi standar, terutama daerah CI-CII & thoraco cervical joint
2. FOTO V. THORACAL & LUMBAL
Proyeksi AP
Proyeksi Lateral
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Meliputi :1. Corpus vertebrae
- Kontur - Alignment- Ukuran – heigt
2. Diameter canalis-spinalis3. Adakah subluxatio4. Adakah kemiringan
Adakah abnormal (abnormal tilting pada corpus vert / facet)
5. Soft tissue swelling prevertebral
PENILAIAN FOTO VERT. CERVICALIS
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ad. Alignment cervical
a.) 4 lengkungan lordotik
- Corpus vert. anterior
- Canalis spinalis anterior
- Canalis spinalis poetrior
- Ujung-ujung proc. Spinosus
b.) garis spinolaminar
= dasar proc. Spinosus bersama dengan canalis spinalis posterior
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KOMPONEN TULANG CERVICAL- Kontur- Sumbu panjang / axial height dari corpus.
vertebrae- Massa tulang lateral :
- pedikel - lamina- facet - proc. tranversus
- Proc. Spinosus- C I, C II & atlanto-occi pital junction
lih : alignment kontur
Adakah : subluxatio rotasi fracture
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KOMPONEN CARTILAGO
• Discus intervertebralis
• Postero – lateral facet joint
KOMPONEN JARINGAN LUNAK PREVERTEBRAL
• garis prevertebral fat
adakah : - obliterasi - pembengkakan
ada cedera cervical
• space antara proc spinusus
ada instabilitas
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TANDA-TANDA ABNORMALITAS VERT. CERVICAL
a. Vertebral malalignment > 3 mm dislokasi
b. Space AP pada canalis spinalis < 13 mm kompressi medulla spinalis
c. Corpus vertebra
Height anterior
< 3 mm height posterior
Fract. kompressi
Lusen pada proc. Odontoid C II Fract
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d. Angulasi intervert. space ( > 110 )
e. Faset-faset pada massa lateral kurang paralel fract. kompresi lateral
f. Lusen pada ujung proc. spinosus fract. avulsi
g. Atlas & Axis ( C1 & C2) :- Jarak antara aspek post C1 ke proc
odontoid anteria bl > 3mm dislokasi- Lusen pada proc odontoid C2
fracture
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h. Space jarak lunak :- Pelebaran prevertebral space (> 5 mm)
ada pendarahan menyertai trauma spinal
- Obliterasi garis prevertebral fat fracture pada level yang sesuai
- Pelebaran space antara proc. spinosus ada robekan ligamen inter spinosus & kemungkinan fract. canalis spinalis anterior
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PENILAIAN FOTO VERT. THORACAL & VERT. LUMBAL
Proyeksi : APLateral
Dinilai :a. Pedikel : bilateral simetrisb. Discus intervertebralis :
- Height - Spacec. Proc. Spinosus :
- Alignmentd. Corpus vertebrae
- Bentuk - Alignment- Kontur