Cervical spine radiography

Background

• Anatomy and general approach similar in plain films and CT

Plain films

• Standard radiographs are thee-view trauma series
• Similar approach of reading plain films to ED screening of a c-spine CT

General

• Most common approach is three parallel vertical column model by Denis
  • 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.

http://radiopaedia.org/articles/three-column-concept-of-spinal-fractures

• Disruption: in one column - generally stable. in two columns - stable in one direction but unstable in another. in three columns - highly unstable.

Approach

• Pneumonic: AABCDS
  • Adequacy - ensure adequate visualization to C7-T1 interface
  • Alignment - Assess alignment of 4 parallel lines
    • Anterior vertebral line
    • Posterior vertebral line
    • Spinolaminar line
    • Posterior spinous line

Alignment of C-Spine

• • AOA - antlanto-occipital alignment - anterior margin of foraement magnum should line up with the dens

Atlanto-occipital alignment

• • • Bony Landmarks - there should be an smooth outline to each of vertebrae

References

http://nypemergency.org/reading_emergency_images/c-spine.html https://www.med-ed.virginia.edu/Courses/rad/cspine/interpretation5.html