what are the standard views of cervical spine Xray?
A/P open mouth A/P Lateral -flex/ext Posterior Oblique
why do an open mouth A/P
visualize the dens
what is the purpose of an A/P and Lateral film
scout for problems
LPO what do you see on this view
-visualize the open right Intervertebral foramen -side marker will be placed in front of the spine, which tells you it is a posterior film
RPO allows you to see what structure?
the open left IVF
what is the position of the pt in for the A/P open mouth Xray view?
supine with mouth open as wide as possible -head straight in neutral position -say "ah" to keep tongue down and out of the way
what structures should you ID from the AP open mouth view?
-Dens or Odontoid process -anterior arch of atlas- frown sign -posterior arch of atlas- smile sign -lateral mass of atlas -transverse process of atlas -atlantoaxial joint space -body of C2 -spinous process of C2 -superior dental arch -infer dental ar
how many types of odontoid fractures are there?
3 type 1, 2, 3
what type of odontoid fracture is stable and thru the upper part of the odontoid?
Type 1 fracture
Type II odontoid fracture
Unstable transverse fracture thru the base of the odontoid process
Type III odontoid fracture
a stable fracture thru the base of the odontoid extending into the body of C2
A blow or direct impact to the top of the head results in what type of fracture?
-results in a burst type fracture of C1 -superior compression causes a bilateral symmetrical fracture of the anterior and posterior arches of C1 -unstable
what fracture in the cervical spine is unstable and causes a distruption of the lateral masses of C1 and the transverse lig?
how will Jefferson Fracture present on a AP open mouth Xray?
-the lateral mass of C1 will hang over C2 -Joint space b/w lateral mass and Dens will increase due to the fracture of the anterior and posterior arches of the atlas
Fracture of the odontoid process
Jefferson Fracture unilateral
what is the position of the pt for AP Lateral Cervical View Xray?
pt is either standing or supine -central beam is directed toward the C4 vertebrae at an angle of 15-20 deg
what is the AP Cervical reading process?
-ID T1 TP - points up - trace C7 TP looking for a cervical rip (points down) -check the uncinate processes -block head reading process: SP, pedicles, shape color -check discs for height and color -trace tracheal air space -check soft tissues
what are the ABCS of radiography?
Alignment Bone Density Cartilage space Soft tissue
what direction does the TP of T1 point?
it points up
what is not evaluated on the AP Lower cervical view?
in the lower cervical spine the cervical vertebrae are not round secondary to the uncinate processes T/F
1) any high risk factors that mandate radiography -yes then RG 2) any low risk factors that mandate radiography - yes then go to 3 3) able to actively rotate neck? No then RG
what are considered high risk factors that mandate radiography for the cervical spine?
Age > 65 yrs Dangerous Mechanism of injury Parathesis in extermities
what are low risk factors that allow for safe assessment of ROM in cervical neck injuries
-simple rear-end MVC -sitting position in ER -ambulatory @ any time -delayed onset of neck pain -absence of middle C-spine tenderness
if you cannot actively rotate neck 45deg left or right then you should get a radiography T/F
what position is the pt in for a lateral view cervical xray?
pt is standing or supine -cental beam is directed horizontally to the center of the C4 vertebra -supine the central beam is directed horizontally to a point o 2.5-3cm caudal to the mastoid tip
what is the single most important view of the cervical spine?
Lateral View xray
Xray Lateral View of Cervical spine -Atantodental Interface (ADI)
what is the ADI
Atlantodental Interface -radiolucent line b/w the odontoid process and the anterior arch of the atlas -must not exceed 3mm on lateral, lateral flex, and lateral extension radiographs
what does it mean if the ADI exceeds 3mm
-unstable transverse ligament of the atlas -indicates C1-C2 subluxation
what are the 4 lines you should trace in the lateral view
Anterior Vertebral Line Posterior Vertebral Line (George's Line) Spinolaminar Line Posterior Spinolaminar line
T/F the Anterior, Posterior and Spinolaminar Lines should be relatively parallel
what represents the sagittal diameter of the spinal cord
distance b/w the posterior vertebral line and the spinolaminar line
what is the cervical reading process for the lateral view?
-check ADI -trace dens- height and color -trace Anterior Vertebral line, Posterior Vert Line, Spinolaminar line -check alignment of Cervical vert and look for osteophytes -check disc space -check facets -trace SP and check spacing -check soft tissues
what 3 spaces are evaluated on the lateral view of the C-spine
ADI no greater than 3mm Retrophayngeal space: 7mm at C2 Retrotracheal space: 20-22 mm at C6
what are the 3 mains lines to observe in lateral C-spine xray
Anterior vertebral line Posterior vertebral line Spinolaminar line
T/F the distance b/w George's line and the Spinolaminar line represents sagittal dimension of the spinal canal
what is the normal dimension of the SC
what is abnormal dimension of the SC
<12 mm = stenosis
what are you looking for in the lateral flex and ext stress views
-look at the 3 lines of alignment -the space b/w SPs for irregularies -ADI < 3mm
Hangman's Fracture -unstable -fracture of pedicles of C2 causing dislocation of C2 on C3 as a result of rapid cervical spine hyperextension
what type of fracture is a fracture of the pedicles on C2 that causes dislocation of C2 on C3 due to rapid hyperextension
Burst Fracture C3-C7 NP is driven through the fractured end plate into the vertebral body comminuted fracture
A vertical spit in the vertebral body on an AP view characterizes what pathology
what is the most severe and unstable fracture of the cervical spine?
Teardrop Fracture -caused by flexion compression injury resulting in posterior displacement of the involved vertebrae
what does a Teardrop fracture involve?
-fracture of the posterior elements -stress applied to the ALL causes rupture or avulse from the vertebral body -triangular teardrop shaped fragment is displaced anteriorly and inferiorly
T/F teardrop fracture is nonuniform with a sclerotic line
fracture of SP of C6, C7, or T! -result of hyperflexion injury along with strong forceful contractions of upper traps and rhomboids -stable
what is the pt position for Oblique View R/L
pt is standing and is rotated 45deg to one side -central beam is directed to the C4 vertebrae with 15-20 deg
what is the Oblique view good for viewing
what do you analyze on the Oblique view
-vertebral bodies -posterior arch of atlas -Intervertebral foramen C2-C3 is the first IVF you see -TP -facet joints
what is the first IVF you see
C2-C3 -C3 spinal nerve exits there
what IVF do you see on the Left PO view?
the Right IVF
what are the common cervical MRI views
T1/T2 weighted sagittal T1/T2 weighted axial
what is the specific reading process of the Sagittal View MRI