Spine CT Recognition Pattern

Systematic approach to interpreting spine CT scans with focus on bony anatomy, trauma, and degenerative changes

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1. Basic Principles

A. Standard Windows

• Bone window:
  - WW 2000, WL 500
  - Assess vertebrae, facets, posterior elements
• Soft tissue window:
  - WW 400, WL 50
  - Discs, ligaments, paraspinal muscles

B. Reconstructions

• Sagittal:
  - Spinal canal assessment
  - Alignment evaluation
• Coronal:
  - Scoliosis evaluation
  - Facet joint symmetry
• 3D reconstructions:
  - Complex fractures
  - Surgical planning

2. ABCS Systematic Approach

Step	Assessment	Key Elements
A	Alignment	Anterior/posterior lines, listhesis
B	Bones	Fractures, lytic/blastic lesions
C	Canal	Stenosis, cord compression
D	Discs	Herniation, degeneration
S	Soft tissues	Ligaments, hematoma, masses

3. Trauma Patterns

A. Cervical Spine Injuries

Injury	Level	Key Features
Jefferson	C1	Burst fracture, lateral mass displacement
Hangman's	C2	Bilateral pars fractures
Teardrop	Lower cervical	Anterior-inferior vertebral fragment
Clay-shoveler's	C6-T1	Spinous process avulsion

B. Thoracolumbar Injuries

• Compression fracture:
  - Anterior wedge deformity
  - Posterior wall intact
• Burst fracture:
  - Retropulsion into canal
  - Posterior element involvement
• Chance fracture:
  - Horizontal through vertebra
  - Seatbelt injury pattern

4. Degenerative Changes

A. Common Findings

• Spondylosis:
  - Osteophytes
  - Endplate sclerosis
• Facet arthropathy:
  - Joint space narrowing
  - Subchondral cysts
• Spondylolisthesis:
  - Graded I-IV (Meyerding)
  - Pars defect (isthmic) vs degenerative

B. Spinal Stenosis

Measurement	Normal	Stenosis
AP canal diameter	≥12mm	<10mm
Lateral recess	≥5mm	≤3mm
Neuroforamen	No narrowing	Nerve root compression

5. Critical Findings

A. Cord Compression

• Bony:
  - Fracture fragments
  - Severe spondylolisthesis
• Soft tissue:
  - Large disc herniation
  - Epidural hematoma

B. Unstable Injuries

• Three-column injuries:
  - Any injury involving posterior elements
  - Requires surgical consultation
• Craniocervical dissociation:
  - Basion-dens interval ≥12mm
  - Power's ratio abnormality

6. Spine CT Reporting Template

1. Technique:
   - Region imaged (C/T/L spine)
   - Reconstructions available
2. Alignment:
   - Normal lordosis/kyphosis
   - Listhesis if present
3. Vertebral bodies:
   - Fractures (type, stability)
   - Degenerative changes
4. Spinal canal:
   - Stenosis degree/level
   - Cord compression
5. Soft tissues:
   - Paraspinal hematoma
   - Ligamentous injury signs

Always correlate with neurological exam and mechanism of injury. For trauma patients, review all reconstructed planes. In degenerative cases, match findings to clinical symptoms. For suspected metastases, evaluate pedicles and posterior elements carefully. Document any critical findings requiring urgent intervention.

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