Standing Lateral Cervical View
head in neutral beam to center of C4
Demonstrates vertebral bodies, apophyseal joints, spinous processes, intervertebral disk
C7 should ALWAYS be demonstrated
Table Lateral C View
Supine with head in neutral, beam directed 2.5-3 cm caudal to mastoid tip
5 contour lines of cervical spine
Retropharyngeal space <7mm Retrotracheal space <22mm adults or <14mm children 1 anterior vertebral line 2 posterior vertebral line 3 spinolaminar line 4 posterior spinous line 5 clivus-odontoid line
Chmerlain Line
posterior margin of foramen magnum to dorsal margin of the hard palate
Odontoid process shoud not project above this line more than 3mm or it indicates AA impaction
McRae Line
line btwn anterior and posterior margin of foramen magnum
Odontoid process should be just below or is indicates AA impaction
AP Cervical View
pt supine or standing
beam directed at C4 at 15-30 degrees cephalad
Demonstrates C3-C7 vertebral bodies and intervertebral spaces
C1-C2 not adequately viewed
Open Mouth View
Pt opens mouth as wide as possible beam directed at midpoint of open mouth
Demonstrates C1-C2
Fuchs View
Pt. supine w/ neck hyperextended, beam directed vertically just below chin
Demonstrates Odontoid
Oblique View
Pt rotated 45 degrees with beam directed at C4 15-20 degrees cephalad (R rotation demonstrates L foramina)
Demonstrates Foramina and apophyseal joints
Swimmers View
Pt prone with 1 arm abducted 180 degrees and other at side, beam directed horizontally at axilla
Demonstrates C7, T1, T2
Occipital Condyle Fx Types
See Image
Jefferson Fx
MOI axial load to head and occipital condyles causing symetrical fxs of anterior and posterior arches of C1 and disruption of transverse ligaments
Odontoid Fx Types
Type 1 - through part of odontoid
Type 2 - whole odontoid breaks off
Type 3 - Fx below odontoid
Hangman’s Fx
MOI - Hyperextension and distraction
Fx identified through the pedicles of C2 and associated ligament disruption
Burst Fx
Seen at C3-C7
Nuleolus pulposes driven through Fx vertebral plate into vertebral body causing comminuted Fx
CT is best for imaging these
Teardrop Fx
MOI - Compression and Flexion
Most severe and unstable C spine injury
Posterior displacement of spinal canal, Fx of posterior elements and disruption of soft tissue
Best viewed with Lateral radiograph
Clay-Shovelers Fx
MOI - Acute powerful flexion or direct blow to C spine
Stable Fx with posterior ligament complex intact
Best view - lateral
Compression (wedge) Fx
MOI - Hyperflexion of C-spine
Anteriro compression of vertebral body
Posterior ligament complex stretched
Best view - lateral
C Spine Step 1
Age over 65
Dangerous Mechanism
Numbness or tingling in extremities
Yes to any = Xray
Dangerous Mechanism Definition
Fall from 3 ft or higher
Bicycle collision
Axial load to the head
MVA involving high speed, rollover or ejection
C Spine Step 2
Simple rear-end MVA Pt ambulatory at any time since injury Delayed onset of neck pain Pt in sitting position in ER No midline cervical tenderness No to all? Xray
C Spine Step 3
Able to actively rotate 45 degrees each way?
No? Xray
Thoracic AP
Supine with *knees flexed
Beam directed vertically 3cm above xiphoid process
Demonstrates vertebral endplates, pedicles and intervertebral disks
Thoracic Lateral View
Pt standing with arms elevated beam directed at T6 with 10 degrees cephalad
AP Lumbar View
Pt supine with knees flexed to eliminate lordosis beam directed at center of abdoment at level of iliac crests
Demonstrates: Vertebral bodies and end plates, transverse processes, intervertebral disk space, spinous process, pedicles
Cupids Bow
Characteristic configuration of end plates of L3-L5
Demonstrated on inferior aspects
Absence indicates possible compression Fx
Lateral View of Lumbar
Pt in sidelying with knees and hips flexed to eliminate lordotic curve, beam vertical at L3
Demonstrates: Vertebral bodies, Pedicles, Spinous Processes, Intervertebral foramina, disk space
Oblique view of Lumbar
Pt 45 degrees from prone beam directed at L3
Demonstrates: Facets, Superior-Inferior articular process, Pedicles, Pars interarticularis
“Scotty Dog”
Lumbar Burst Fx
MOI: Axial compression or a combo of compression w/rotation or anterior or lateral flexion
Hallmark: Widening of interpediculate distance
Seatbelt Fx
Horizontal splitting of the vertebra beginning in spinous process or lamina and extending through the pedicles and vertebral bodies
Spondylolysis
Defect in the pars interarticularis
Andvanced form - Spondylolisthesis
90% occur at L4-L5 or L5-S1
Spinous process sign
true spondy has defect in pars interarticularis
Grading a Spondy
Divide vertebral body into 4. Grade 1-4 based on how many quarters have slipped off
Spondylosis Deformans
degenerative condition, large osteophytes on anterior aspect of adjacent vertebral bodies
Anterior disk herniation
