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49 - Cervical spine x-ray

from Section 11 - Surgical radiology

Published online by Cambridge University Press:  05 July 2015

Hardi Madani
Affiliation:
Clinical Radiology, Royal Free Hospital, London Deanery, London, UK
John Curtis
Affiliation:
University Hospital Aintree, Liverpool, UK
Helen Marmery
Affiliation:
Royal Free Hampstead NHS Trust, London, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Introduction

‘This is an x-ray of the cervical spine in AP/lateral/open-mouth view. It is (is not) an adequate film because C1 to C7/T1 junction have (have not) been included.’

Summary

  1. A Address

  2. A Adequate

  3. A Alignment

  4. B Bone

  5. C Cartilage

  6. E Everything else

Checklist

Address

• Name and date of birth

Adequate (views)

• Non-trauma: AP and lateral

• Trauma:

1. AP

2. lateral, C1 to C7/T1

3. peg view/open mouth

Alignment

• Lateral view:

• anterior longitudinal line

• posterior longitudinal line

• spinolaminar line

• spinous process (interspinous) line

• AP view:

• transverse spinous processes line up

• posterior spinous processes align themselves when seen ‘end on’

• Peg view:

• equal spaces on either side of C1 peg to C2 body

• lateral margins of C1–C2 align; if not aligned, suggestive of C1 blow-out (Jefferson) fracture

Bone

• Lateral view:

• all vertebral body heights must be the same

• anterior and posterior aspects of vertebral bodies should be concave

• AP view:

• spinous processes lie in straight line and are equidistant from each other

• the lateral edges of the vertebral bodies should all be equally aligned

• all vertebral bodies have two pedicles (owl eyes) – if not this suggests lytic destruction of pedicle (spinal tumour – usually metastatic)

• an increase in the interpedicular distance compared to the vertebral levels below is indicative of a burst type fracture

• Peg view:

• C2 vertebra odontoid process (peg) intact

• lateral margins of C1 and C2 align; failure of alignment suggests blow-out fracture of C1 (Jefferson's fracture)

Cartilage and ligaments

• Increased prevertebral soft tissue thickness is abnormal and can be a sign of a haematoma and occult fracture. Abnormal thickness is defined either in relation to the size of the adjacent vertebra or in millimetres.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 414 - 417
Publisher: Cambridge University Press
Print publication year: 2015

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