Cervical spine x-ray interpretation: Difference between revisions

Revision as of 02:10, 24 April 2017

Make sure that the C7-T1 junction is adequately visualized
- Obtain swimmer's view or oblique view if inadequate
Peds
- Most pediatric fractures 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
Most common approach is to evaluate three parallel vertical columns
- Anterior column: alternating vertebral bodies and intervertebral disks surrouded by anulus fibrosus and anterior longitudinal ligament
- Middle column: posterior parts of annulus fibrosis and posterior vertebral wall, posterior lognitudinal ligament, spinal cord, paired laminae and pedicles, articulating facets, transverse processes, nerve roots and vertebral arteries/veins
- Posterior column: spinous process, nuchal ligament, interpsinous and supraspinous ligaments, and ligamentum flavum.
- Disruption of one column is generally stable. Disruption of two or more is unstable.

Lateral film

Predental space (anterior aspect of odontoid to post aspect of ant ring of C1)
- Adult <3mm
- Peds <5mm
- Widening of space suggests Jefferson burst fracture 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

Alignment
- Disruption in the anterior, posterior, or spinolaminal lines
Bones
- Obvious fracture
- 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 fracture
  - Widening: posterior ligamentous injury
Soft tissue
- Widening of the prevertebral soft tissue suggests fracture

Authors:

@@ Line 3: / Line 3: @@
 **Obtain swimmer's view or oblique view if inadequate
 *Peds
-**Most pediatric fracture occur higher than C3
+**Most pediatric fractures occur higher than C3
 **Pseudosubluxation of C2-C3 is common in children <8yr
 ***To distinguish from true dislocation or fracture:
@@ Line 10: / Line 10: @@
 *Most common approach is to evaluate three parallel vertical columns
 **Anterior column: alternating vertebral bodies and intervertebral disks surrouded by anulus fibrosus and anterior longitudinal ligament
-**Middle column: poster parts of annulus fibrosis and posterior vertebral wall, posterior lognitudinal ligament, spinal cord, paired laminae and pedicles, articulating facets, transverse processes, nerve roots and vertebral arteries/veins
+**Middle column: posterior parts of annulus fibrosis and posterior vertebral wall, posterior lognitudinal ligament, spinal cord, paired laminae and pedicles, articulating facets, transverse processes, nerve roots and vertebral arteries/veins
-**Posterior column: spinous process, nuchal ligament, ineterpsinous and suprspinous ligaments, and ligamentum flavum.
+**Posterior column: spinous process, nuchal ligament, interpsinous and supraspinous ligaments, and ligamentum flavum.
 **Disruption of one column is generally stable. Disruption of two or more is unstable.