Cervical spine x-ray interpretation: Difference between revisions
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==Background== | ==Background== | ||
*Make sure that the C7-T1 junction is adequately visualized | |||
**Obtain swimmer's view or oblique view if inadequate | |||
*Peds | |||
**Most peds fx occur higher than C3 | |||
**Pseudosubluxation of C2-C3 is common in children <8yr | |||
***To distinguish from true dislocation or fracture: | |||
****Draw line from cortex of post arch of C1 to cortex of posterior arch of C3 | |||
****This line should pass through or be <1mm ant to posterior arch of C2 | |||
==Measurements (Normal)== | ==Measurements (Normal)== | ||
*Predental space (anterior aspect of odontoid to post aspect of ant ring of C1) | |||
**Adult <3mm | |||
**Peds <5mm | |||
**Widening of space suggests [[Jefferson fracture|Jefferson]] burst fx of C1 | |||
*Anterior soft tissue | |||
**Distance between ant border of C2 and post pharynx should be <6mm in adults and peds | |||
**Distance between ant border of C6 and post trachea should be <22 mm in adults | |||
***Should be <14mm in children <15yr or less than width of vertebral body at each level | |||
*Bones | |||
**Vertebral body: Anterior height should be no more than 3mm shorter than posterior height | |||
==Lateral== | ==Lateral== | ||
*Alignment | |||
**Disruption in the anterior, posterior, or spinolaminal lines | |||
*Bones | |||
**Obvious fx | |||
**Disruption of ring of C1 | |||
**Double facet sign indicates fractured articular facet | |||
**Loss of vertebral height | |||
*Cartilage | |||
**Intervertebral disc space height and length should be uniform | |||
***Narrowing: disc herniation or adjacent vertebral fx | |||
***Widening: posterior ligamentous injury | |||
*Soft tissue | |||
**Widening of the prevertebral soft tissue suggests fx | |||
==AP View== | ==AP View== | ||
*Alignment of spinous processes | |||
*Distance between spinous processes | |||
*Uniformity and height of vertebrae | |||
==Odontoid== | ==Odontoid== | ||
*Spacing of dens and lateral masses | |||
*Lateral alignment of C1 and C2 | |||
*Uniformity of bones | |||
== X-ray vs CT == | == X-ray vs CT == | ||
*Plain radiographs may be appropriate in low-risk patients | |||
*High risk patients requiring CT: | |||
**Closed head injury | |||
**Neurologic deficits | |||
**High energy trauma | |||
**Unreliable examination | |||
**Pain out of proportion to exam | |||
**Inadequate plain films | |||
==See Also== | ==See Also== | ||
Revision as of 11:45, 11 June 2015
Background
- Make sure that the C7-T1 junction is adequately visualized
- Obtain swimmer's view or oblique view if inadequate
- Peds
- Most peds fx occur higher than C3
- Pseudosubluxation of C2-C3 is common in children <8yr
- To distinguish from true dislocation or fracture:
- Draw line from cortex of post arch of C1 to cortex of posterior arch of C3
- This line should pass through or be <1mm ant to posterior arch of C2
- To distinguish from true dislocation or fracture:
Measurements (Normal)
- Predental space (anterior aspect of odontoid to post aspect of ant ring of C1)
- Adult <3mm
- Peds <5mm
- Widening of space suggests Jefferson burst fx of C1
- Anterior soft tissue
- Distance between ant border of C2 and post pharynx should be <6mm in adults and peds
- Distance between ant border of C6 and post trachea should be <22 mm in adults
- Should be <14mm in children <15yr or less than width of vertebral body at each level
- Bones
- Vertebral body: Anterior height should be no more than 3mm shorter than posterior height
Lateral
- Alignment
- Disruption in the anterior, posterior, or spinolaminal lines
- Bones
- Obvious fx
- Disruption of ring of C1
- Double facet sign indicates fractured articular facet
- Loss of vertebral height
- Cartilage
- Intervertebral disc space height and length should be uniform
- Narrowing: disc herniation or adjacent vertebral fx
- Widening: posterior ligamentous injury
- Intervertebral disc space height and length should be uniform
- Soft tissue
- Widening of the prevertebral soft tissue suggests fx
AP View
- Alignment of spinous processes
- Distance between spinous processes
- Uniformity and height of vertebrae
Odontoid
- Spacing of dens and lateral masses
- Lateral alignment of C1 and C2
- Uniformity of bones
X-ray vs CT
- Plain radiographs may be appropriate in low-risk patients
- High risk patients requiring CT:
- Closed head injury
- Neurologic deficits
- High energy trauma
- Unreliable examination
- Pain out of proportion to exam
- Inadequate plain films
See Also
Source
Cervical Spine Injury, EB Medicine, April 2009