The cervical spine appears otherwise unremarkable. Some mild degenerative arthritic changes can be seen at the intervertebral joints at C7-T1. There is a fracture through the spinous process of C7 with approximately 5mm posterior and caudad displacement of the fragment. Careful look for serious injury – neg.ĥ5 Clay shovelers. Careful look for serious injury – neg.ĥ4 Clay shovelers. There is a fracture-dislocation at the C2, C3 level with approximately 2 mm anterior displacement of C2 on C3.ĥ2 Patient 9 28 year old male complains of a sore neck the day after a fight in a bar.ĥ3 Clay shovelers. Quadriplegic, but survived.Ĥ9 Patient 8 22 year-old male Hyperextension injury: stopped on highway, hit from behind by transport. Quadriplegic, but survived.Īfter the x-ray Transferred for surgery. A-6-1Ĥ7 ?Jefferson - >2mm bilat C2 Lat offset.Ĥ8 Transferred for surgery. Lat c-spine first – proceed if normal A-P Odontoid view No data on obliques – but some docs like them! Obliques can be helpful in seeing C7-T1 Flexion-extension views rarely or never show fracture when other views are normal In 30% of trauma cases, flex-ext is inadequate for diagnosis However, it is recommended ahead of MRI can show ligamentous injuryġ2 (4) (3) A (1) (2) B The cross table lateral is usually done first at 48” or 72” Swimmers view done if C7-T1 junction not visualized with cassette next to raised arm Interpretation Technique (Mneumonic: ABCDS) Adequate film and Alignment Bony landmarks Cartilaginous space Discs Soft tissue spaces Adequate film criteria Visualize all seven vertebrae (including C7-T1) Maneuvers to enhance view of lower C-Spine C7-T1 Pull down on arms during cross-table lateral Swimmer's View Cervical Spine CT Alignment Assessment criteria Landmarks should line up with =3 mm is abnormal Angulation >11 degrees is unstable Trace unbroken outline of each vertebrae Trace odontoid outline from C2 vertebrae Predental space Distance from dens to C1 body Normal values Adult: 3mm Child: 5mm Assess symmetry of disc spaces Soft Tissue spaces Soft Tissue stripe Normal C2 stripe: 5 mm Normal C5 stripe: 20 mm Normal Fat tissue stripe 2mm bilat C2 Lat offset bilat. Predental space widening SCIWORA is more common Make interpretation difficult Canadian C-spine rules don’t applyĩ What views to order Routine trauma series: Injuries over 48 hrs old Minor injuriesĨ Pediatrics Epiphyses Fusion lines Pseudosubluxation Anterior wedging Known vertebral disease: RA, spinal stenosis, etc. Mower et al Ann Emerg Med 2001 n=34,069 3 views missed 0.1% of fractures Only missed 0.008% of unstable injuries 30% of missed injuries due to inadequate filmsħ Patients excluded: Under 16 years old Unstable Acute paralysis When to x-ray Accuracy of x-ray What’s normal CasesĤ% of patients have c-spine fracture without neurological deficit 1% have spinal cord injury Karl Stobbe MD Beamsville, ON Peter Hutten-Czapski MD New Liskeard, ON Neil Leslie MD Revelstoke, BC Trina Larsen Soles MD Golden, BC Presentation on theme: "C-Spine X-ray Interpretation"- Presentation transcript:
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |