Servikal vertebral subluksasyon

Özet

Travmatik servikal subluksasyon, komşu vertebralar veya faset eklemleri arasındaki uyumun kısmen kaybolduğu ve sıklıkla fleksiyon-distraksiyon ya da rotasyonla gelişen bir yaralanmadır. Kontrastsız ince kesit BT, vertebra translasyonunu, fasetlerin örtüşmesini ve eşlik eden kırıkları hızla ortaya koyar; disk ve bağ hasarının kapsamı BT’de tam görünmeyebilir. Faset eklem örtüşmesindeki küçük değişiklikler veya eklem aralığında genişleme, altta yatan diskoligamentöz hasarı gösterebilir. Akut travmatik subluksasyonun dejeneratif veya konjenital değişikliklerle ayırıcı tanısı yapılmalı, travma bulguları dikkatle değerlendirilmelidir.

Faz ve pencere

Kontrastsız tanısal

Sagittal kemik rekonstrüksiyonlarında komşu korpusların ön ve arka kontur çizgilerindeki basamak, faset örtüşme kaybı, perched/jumped faset ve disk aralığında asimetrik açılma görülür; aksiyel kesitler rotasyonu ve tek ya da çift taraflı eklem uyumsuzluğunu gösterir. Travmatik kemik deformitesi ve hizalanma bozuklukları kontrastsız BT ile yüksek doğrulukla saptanır.

Kemik algoritması tanısal

Kemik rekonstrüksiyonu fasetlerin birbirine göre konumunu, eklem yüzlerinde kilitlenme veya örtüşme kaybını ve translasyona eşlik eden faset, lamina ya da korpus kırıklarını gösterir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Korpus çizgilerinde basamak — komşu vertebraların ön, arka veya spinolaminar konturları düzgün devam etmez.
• Faset örtüşmesinde azalma — üst vertebranın inferior artiküler faseti alt vertebranın superior fasetiyle normal karşılıklı konumunu kaybeder.
• Faset kilitlenmesi — travmatik C5–C6 dislokasyonuna tek taraflı faset eklemi kilitlenmesi eşlik edebilir.
• Rotasyonel faset asimetrisi — aksiyel görüntüde eklem aralığı açılır ve bir tarafta faset yüzleri karşılıklı temasını kaybeder.
• Disk aralığında kama biçimli açılma — travmatik distraksiyonda ön veya arka disk aralığı komşu seviyelere göre genişleyebilir.
• Segmental kifoz veya anterolistezis — vertebra gövdesi alt komşusuna göre öne kayar ve lokal lordotik hat bozulur.
• Eşlik eden kırık veya kanal daralması — faset, endplate ya da posterior eleman fragmanı spinal kanal sınırını değiştirebilir.
• Prevertebral yumuşak doku kalınlaşması — travma düzeyinde hematom veya ödem eşlik edebilir, ancak tek başına subluksasyon tanısı koydurmaz.

Ölçütler ve sınıflamalar

Faset eklemi örtüşmesi

Komşu artiküler yüzlerde normal örtüşmenin kaybı veya artan vertebral translasyon, eklem ilişkisinin bozulduğunu ve travmatik yaralanmayı düşündürür.

AO Spine subaksiyel servikal faset sınıflaması

AO Spine alt servikal sınıflamasında C-F4 alt tipi kullanılır; faset çıkığı olan 36 hastalık bir seride en sık lezyon tipi C-F4 olarak bildirilmiştir (25/36). AO Spine sınıflaması yaralanma morfolojisini ve faset eklemi hasarını sınıflandırmada dikkate alır.

Subaxial Cervical Injury Classification (SLIC)

SLIC sistemi yaralanma morfolojisini, diskoligamentöz kompleksin bütünlüğünü ve nörolojik durumu birlikte değerlendirir. Diskoligamentöz kompleks sağlam, belirsiz veya bozulmuş; nörolojik durum ise sağlam, kök yaralanması, tam ya da inkomplet kord yaralanması olarak sınıflandırma bileşenlerine eklenir.

Normalde

Normal servikal segmentte korpusların ön ve arka konturları düzgün çizgiler halinde devam eder; üst-alt artiküler fasetler düzenli örtüşür ve disk aralığı benzer komşu seviyelerle uyumludur. Yaralı seviyeyi üst-alt segmentlerle ve karşı taraf fasetiyle kıyaslayarak translasyon yönünü, eklem örtüşmesini, disk açısını ve lokal kifozu belirleyin.

Ayırıcı tanı

Kronik dejeneratif spondilolistezis

osteofit, disk aralığı daralması ve faset artrozu eşlik eder; akut disk aralığı açılması ya da kırık hattı beklenmez.

Pozisyonel rotasyon

vertebra ve posterior elemanlar birlikte döner, ancak faset yüzlerinde gerçek atlama veya keskin translasyon görülmez.

Konjenital faset asimetrisi

eklem yüzleri düzgün kortike ve kronik biçimde şekillenmiştir; komşu yumuşak doku travma bulgusu bulunmaz.

Faset eklem kırığı

eklem yüzünde ayrılmış fragman vardır, fakat subluksasyon olmadan da izole kırık görülebilir.

Servikal kifotik dizilim

lordoz kaybı tek başına travmatik kayma değildir; korpus çizgileri ile faset ilişkileri korunmuş olabilir.

Tuzaklar

• Rotasyon ve translasyonu ayırt etmek için faset eklemlerinin konumu ve korpus hizalanması birlikte değerlendirilmelidir.
• Dejeneratif retrolistezis travmatik anterolistezis gibi görünebilir; disk daralması, osteofit ve faset sklerozu kronik zemini destekler.
• Kilitli faset bulgusunu travmatik dislokasyonla birlikte değerlendirin; BT’de dislokasyona tek taraflı faset kilitlenmesi eşlik edebilir.
• BT’de hafif hizalanma bulgusu olması bağların sağlamlığını kanıtlamaz; belirgin diskoligamentöz şüphede BT’nin yumuşak doku sınırını rapor dilinde koruyun.

Kendini dene

1. C6, C7’ye göre öne kaymış; sagittal BT’de inferior faset superior fasetin tepesine oturmuş. En uygun tanım hangisidir?

   • Perched faset subluksasyonu
   • Dejeneratif retrolistezis
   • İzole lamina kırığı
   • Konjenital blok vertebra
   Cevabı göster

   Perched faset subluksasyonu. Faset yüzünün karşı eklem çıkıntısının tepesine oturması perched faset görünümüdür ve anterior kaymayla subluksasyonu destekler. Dejeneratif retrolistezis arkaya kayma ve kronik dejenerasyonla; lamina kırığı kortikal hatla; blok vertebra füzyonla tanınır.

2. Alt servikal omurgada translasyon/rotasyon yaralanmalarını değerlendirmek için vertebral translasyonun bildirilen normal üst sınırı kaç milimetredir?

   • 2,0 mm
   • 1,54 mm
   • 1,27 mm
   • 3,0 mm
   Cevabı göster

   2,0 mm. S101, vertebral translasyon için 2,0 mm normal üst sınır bildirir. 1,54 mm ve 1,27 mm ise faset eklemi yüksekliğinin anterior ve posterior ölçümlerine ait üst sınırlardır.

İlgili konular

• Servikal translasyonel kırık-çıkık
• Tek taraflı faset kilitlenmesi/çıkığı
• Çift taraflı faset kilitlenmesi/çıkığı
• Subaxial Injury Classification (SLIC)

Kaynaklar

Bu sayfadaki 46 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.