Cervical spine x-ray interpretation

Background

1. Make sure that the C7-T1 junction is adequately visualized
   1. Obtain swimmer's view or oblique view if not
2. Peds
   1. Most peds fx occur higher than C3
   2. Pseudosubluxation of C2-C3 is common in children <8yr
      1. To distinguish from true dislocation or fracture:
         1. Draw line from cortex of post arch of C1 to cortex of posterior arch of C3
         2. This line should pass through or be <1mm ant to posterior arch of C2

Measurements (Normal)

1. Predental space (anterior aspect of odontoid to post aspect of ant ring of C1)
   1. Adult <3mm
   2. Peds <5mm
   3. Widening of space suggests Jefferson burst fx of C1
2. Anterior soft tissue
   1. Distance between ant border of C2 and post pharynx should be <6mm in adults and peds
   2. Distance between ant border of C6 and post trachea should be <22 mm in adults
      1. Should be <14mm in children <15yr or less than width of vertebral body at each level
3. Bones
   1. Vertebral body
      1. Anterior height should be no more than 3mm shorter than posterior height

Lateral

1. Alignment
   1. Disruption in the anterior, posterior, or spinolaminal lines
2. Bones
   1. Obvious fx
   2. Disruption of ring of C1
   3. Double facet sign indicates fractured articular facet
   4. Loss of vertebral height
3. Cartilage
   1. Intervertebral disc space height and length should be uniform
      1. Narrowing: disc herniation or adjacent vertebral fx
      2. Widening: posterior ligamentous injury
4. Soft tissue
   1. Widening of the prevertebral soft tissue suggests fx

AP View

1. Alignment of spinous processes
2. Distance between spinous processes
3. Uniformity and height of vertebrae

Odontoid

1. Spacing of dens and lateral masses
2. Lateral aligment of C1 and C2
3. Uniformity of bones

X-ray vs CT

1. Plain radiographs are appropriate in low-risk patients
2. High risk patients requiring CT
   1. Closed head injury
   2. Neurologic deficits
   3. High energy trauma
   4. Unreliable examination
   5. Pain out of proportion to exam
   6. Inadequate plain films

See Also

C-Spine (NEXUS)

Source

Cervical Spine Injury, EB Medicine, April 2009