Cervical spine

Published on 01/04/2015 by admin

Filed under Radiology

Last modified 01/04/2015

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Cervical spine

The standard radiographs

Three-view trauma series.

Analysis: the checklists

Injuries are most often missed because of poor radiographic technique and/or inaccurate film interpretation1,2,46. Most errors are avoidable5. Missed C-spine abnormalities occur most commonly at the top or at the bottom of the C-spine1,2.

Priority 1: Lateral view checklist

Identify the odontoid peg and assess its position and anatomical relationship to the C1 vertebra. Overlapping structures (eg mastoid, ear lobes, C1 vertebra) can make this difficult. Questions 1–5 will help you to overcome this.

Ask yourself ten important questions:

Question 6. Harris’ Ring7. Many lateral views will show a white ring projected over the base of the Peg and over part of the body of C2 (see above). This ring may appear slightly incomplete at its inferior and/or superior aspects—that is a normal appearance. However, if either the anterior or posterior margin of the ring appears disrupted then a fracture through the base of the Peg or the body of C2 is very possible and a C2 fracture will need to be excluded (p. 188).

Question 7. Check that the posterior arches of C1 and C2 are intact.

Potential Pitfall: Line 3 will sometimes show a slight step at the C2 level, particularly in children8.

Apply this rule: this step should not be more than 2 mm posterior to the smooth arc as it is traced upwards between C3 and C1 vertebrae.

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Question 10. Are the pre-vertebral soft tissue shadows normal? The soft tissue shadow7,911 anterior to the vertebral bodies has a characteristic configuration and width. Any bulge or local increase in width indicates haemorrhage and connotes an important injury.

NB: The absence of a bulge does not exclude a ligamentous or bone injury. Indeed, even with a major injury, a soft tissue bulge due to a haematoma is fairly rare.

Priority 2: AP Peg view checklist

The anatomical arrangement of the C1–C2 articulation allows extensive neck rotation whilst providing maximum stability. This stability depends on the integrity of the ligaments, particularly the C2 transverse ligament. Various other ligaments enable C1 vertebra to be held in the optimal position above the body of C2 vertebra. Any deviation from this alignment indicates either ligamentous disruption or a broken vertebra.

Ask yourself three important questions:

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