![]() Computed tomography (CT) was first introduced in the 1970s but did not prove adequate for the evaluation of the acutely injured spine until the early 2000s with the introduction and perfection of multidetector CT (MDCT), with rapid exposures coupled with the development of immediate and readily accomplished multiplanar image reconstructions. Though traditional and long the mainstay of cervical spine evaluation, radiographs of the cervical spine now have a limited role in the initial assessment of cervical spine trauma. Teardrop fractures at anterior margins of vertebral bodiesĬlosely evaluate prevertebral soft tissues for swelling. Spondylosis and degenerative changes in elderlyĬheck for evidence of hyperextension injury. Obtain an MRI for those with neurologic signs and symptoms.Ĭheck width of spinal canal for spinal stenosis. Where to look when you see nothing at all Two- or three-level fractures encountered in 20% of spinal fracturesĬT entire T and L spine after identifying fracture of C-spineįind a compression fracture: look for associated posterior element injury.įind a vertebral body injury: look for bony compromise of spinal canal.įind a facet malalignment on one side: look for contralateral facet malalignment/fracture. Where else to look when you see something obviousįind an injury at one level: closely evaluate the entire cervical spine above and below.įractures of C1 and C2 often associated with fractures of the lower cervical spine (C4-C7) Subtle fractures on radiography – need CT Relatively more involve lower cervical spine, C4-C7 Spinal cord injury without radiographic abnormality (SCIWORA)Īt and beyond 14 years of age injuries similar to those of adults Rare – apophyseal separations of synchondrosis between dens and body of C2 Relatively more involve upper cervical spine Often with either subtle or even without overt radiographic abnormality (SCIWORA)įracture of inferior or superior anterior margins of vertebral bodyįracture of osteophyte at superior or inferior anterior margin of vertebral bodyįractures in DISH (diffuse idiopathic skeletal hyperostosis)Ĭommon sites of injury in children and adolescentsĬervical spine injury ( CSI) rare in children under 8 years of age Spinal cord injury in presence of significant degenerative arthritis and disc disease Intervertebral disc, joint capsules, and interspinous ligamentĪnterior and posterior longitudinal ligamentsįacets – unilateral or bilateral – rotation, shearing injuries Vertical sagittal split of vertebral body ![]() Jefferson fracture – fractures of ring anterior and posteriorĬ2 pars interarticularis fractures – hangman’s fractureĬompression, distraction, and translation/rotation injuries (SLIC) non-angled AP radiograph of C1 and C2.Axial, sagittal, and coronal noncontrast images in bone algorithmĮxtending through at least the level of T1Īxial and sagittal images in soft tissue algorithmĬraniocervical junction (Skull base – C2).specialized projections of the cervical spine often requested to assess for spinal stability.modified lateral projection of the cervical spine to visualize the C7/T1 junction.demonstrated the intervertebral foramina of the side positioned closer to the image receptor.demonstrates the intervertebral foramina of the side positioned further from the image receptor.also known as a 'peg' projection it demonstrates the C1 (atlas) and C2 (axis).anterior-posterior relationship of the vertebral bodies.soft tissue structures around the c spine.anteroposterior projection of the cervical spine demonstrating the vertebral bodies and intervertebral spaces.Note: in the absence of CT 5 views of the C-spine should be performed: AP, lateral, obliques and odontoid 5. IndicationsĬervical spine radiographs are indicated for a variety of settings including 1-3:Ī decision to pursue C-spine imaging of any kind should be cross-referenced with the 'Canadian C-Spine Rule' for C-spine imaging due to its high sensitivity and specificity 4. The cervical spine series is a set of radiographs taken to investigate the bony structures of the cervical spine, albeit commonly replaced by the CT, the cervical spine series is an essential trauma radiograph for all radiographers to understand.
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