Cervical spine x-ray interpretation

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)

• 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
• 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

• Blunt neck trauma
• C-Spine (NEXUS)
• C-Spine (Canadian Rule)

Source

Cervical Spine Injury, EB Medicine, April 2009