Cervical spine x-ray interpretation: Difference between revisions
(→Source) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Make sure that the C7-T1 junction is adequately visualized | *Make sure that the C7-T1 junction is adequately visualized | ||
**Obtain swimmer's view or oblique view if inadequate | **Obtain swimmer's view or oblique view if inadequate | ||
| Line 9: | Line 8: | ||
****Draw line from cortex of post arch of C1 to cortex of posterior arch of C3 | ****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 | ****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: 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 | |||
**Posterior column: spinous process, nuchal ligament, ineterpsinous and suprspinous ligaments, and ligamentum flavum. | |||
**Disruption of one column is generally stable. Disruption of two or more is unstable. | |||
[[File:HWS seitlich Annotation.jpg|thumb|Lateral film]] | |||
==Measurements (Normal)== | ==Measurements (Normal)== | ||
| Line 22: | Line 28: | ||
**Vertebral body: Anterior height should be no more than 3mm shorter than posterior height | **Vertebral body: Anterior height should be no more than 3mm shorter than posterior height | ||
==Lateral== | ==Lateral View== | ||
* | *'''A'''lignment | ||
**Disruption in the anterior, posterior, or spinolaminal lines | **Disruption in the anterior, posterior, or spinolaminal lines | ||
* | *'''B'''ones | ||
**Obvious fx | **Obvious fx | ||
**Disruption of ring of C1 | **Disruption of ring of C1 | ||
**Double facet sign indicates fractured articular facet | **Double facet sign indicates fractured articular facet | ||
**Loss of vertebral height | **Loss of vertebral height | ||
* | *'''C'''artilage | ||
**Intervertebral disc space height and length should be uniform | **Intervertebral disc space height and length should be uniform | ||
***Narrowing: disc herniation or adjacent vertebral fx | ***Narrowing: disc herniation or adjacent vertebral fx | ||
***Widening: posterior ligamentous injury | ***Widening: posterior ligamentous injury | ||
* | *'''S'''oft tissue | ||
**Widening of the prevertebral soft tissue suggests fx | **Widening of the prevertebral soft tissue suggests fx | ||
| Line 42: | Line 48: | ||
*Uniformity and height of vertebrae | *Uniformity and height of vertebrae | ||
==Odontoid== | ==Odontoid View== | ||
*Spacing of dens and lateral masses | *Spacing of dens and lateral masses | ||
*Lateral alignment of C1 and C2 | *Lateral alignment of C1 and C2 | ||
*Uniformity of bones | *Uniformity of bones | ||
== X-ray vs CT == | ==X-ray vs CT== | ||
*Plain radiographs may be appropriate in low-risk patients | *Plain radiographs may be appropriate in low-risk patients | ||
*High risk patients requiring CT: | *High risk patients requiring CT: | ||
| Line 64: | Line 70: | ||
==References== | ==References== | ||
<references/> | |||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 04:48, 8 March 2016
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:
- 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
- Posterior column: spinous process, nuchal ligament, ineterpsinous and suprspinous ligaments, and ligamentum flavum.
- Disruption of one column is generally stable. Disruption of two or more is unstable.
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 View
- 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 View
- 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