Cervical spine x-ray interpretation
Background
Disruption of one column is generally stable. Disruption of two or more is unstable.
- Make sure that the C7-T1 junction is adequately visualized
- Cervical Spine Radiographic series contains 3 views
- Anteroposterior
- Lateral
- Open mouth odontoid view
- Cervical Spine Radiographic series contains 3 views
- Look for alignment of four parallel vertical columns that follow a slightly lordotic curve without any step offs
- Anterior Vertebral Line: anterior to the vertebral body alternating with intervertebral disks surrouded by anulus fibrosus and anterior longitudinal ligament
- Posterior Vertebral Line: posterior to the vertebral body alternating with intervertebral disks surrouded by anulus fibrosus and posterior longitudinal ligament
- Spinolaminar Line- anterior edge of the spinous process
- Posterior Spinous Line-spinous process, nuchal ligament, interpsinous and supraspinous ligaments, and ligamentum flavum
Pediatric
- In patients less than 7 years old, most common mechanism for C-Spine injury was from motor vehicle crashes with injuries in the axial (occiput-C2) region
- In patients 8-15 years old, sports and motor vehicle crashes account for the most common mechanisms with injuries in the sub axial C3-C7) region. Most pediatric fractures occur higher than C3 (from proportionally larger head)[1]
- Pseudosubluxation of C2-C3 is common (~40%) 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 (Swischuk line)
- This line should pass through or be <2mm ant to posterior arch of C2
- To distinguish from true dislocation or fracture:
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 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
Lateral View
- 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
- Intervertebral disc space height and length should be uniform
- Soft tissue
- Widening of the prevertebral soft tissue suggests fracture
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
See Also
- Blunt neck trauma
- Cervical spine clearance
- Canadian cervical spine rule
- NEXUS cervical spine rule
- X-ray interpretation (main)