Medische beeldvorming van de cervicale wervelzuil
1. Radio-anatomie
2. Technieken
a. Radiografie/RX
- Initieel onderzoek bij:
o Cervicale klachten
o Cervico-brachialgie (spinale zenuwen)
Spinale zenuw
komt onder de
wervel uit (7 C
wervels en 8 C
zenuwen)
C6: duim
C7: wijs en middelvinger
C8: ringvinger en pink
o Na trauma: whiplash
- Detectie
o Arthrose (3types): artritis
o Fracturen, alignatiestoornissen en instabiliteit
o Andere afwijkingen
- Postoperatief: spondylodese
o Intercorporele kooi (cage)
o Anterieure plaat en schroef osteosynthese
- Soorten opnames
o VA, profiel, links en rechts schuin (3/4)
o Cranio-cervicale overgang: transbuccaal en profiel
o Cervico-thoracale overgang C7-T1: profiel en swimmers view
o Dynamische opnamen: flexie, extensie en LF
o Transbuccale opname: met de mond open
Dens axis
Lateraal massief C1
Processus transversus C1
Articulatio atlanto-axialis
Articulatio atlanto-occipitalis
- Interpretatie: ABC-s
, b. CT
- Indicaties
o Discus is GEEN indicatie (=MR)
o Indien onvoldoende info op RX
o Trauma
C0-C1/2, C7, T1
Fracturen en luxaties
Losse botfragmenten
Facetgewrichten (fracturen en (sub)luxaties)
o Arthrose – osteofyten
Posterieur (+degeneratief discuslijden)
Uncoarthrose
Facetarthrose
o Postoperatief
Osteosynthesemateriaal
Osseuze overbrugging in kooien van intercorporele fusie
c. MRI
T1: zwart = vocht
T2: wit = vocht
- Voordelen
o Alle cervicale segmenten
o Ruggenmerg
o Discus
o Zenuwwortels
- Nadeel: BOT = ZWART
o CT beter voor: fracturen, fragmenten, osteofyten, uncartrose
- Indicaties
o Discushernia: discusbulging
o Spondylodiscitis
o Ruggenmerg en zenuwwortelcompressie
o Ruggenmergletsels
o Zenuwwortelavulsie
o Plexusletsels
o Tumoren – metastasen
3. Discushernia
a. Mediaan
b. Paramediaan
c. Foraminaal
Druk op: duraalzak, uittredende zenuwwortels, RM
Spinaalkanaalstenose: welke wortel + L of R
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