Cervical spine fracture and dislocation

Cervical spine fracture and dislocationCreated OnMay 4, 2020Last Updated OnMay 5, 2020byadmin You are here: Main Radiology Cervical spine fracture and dislocation < All Topics Table of Contents The 3 standard views are – Lateral, Anterior-Posterior (AP), Odontoid Peg (Open Mouth) Additional views If the lateral view does not show the vertebrae down to T1 then a repeat view with the arms lowered or a ‘Swimmer’s view’ may be required C-Spine systematic approach – Normal Lateral 1 Coverage – All vertebrae are visible from the skull base to the top of T2 (T1 is considered adequate), repeat with ‘swimmer’s’ view if T1 is not visible Alignment – Check the Anterior line (the line of the anterior longitudinal ligament), the Posterior line (the line of the posterior longitudinal ligament), and the Spinolaminar line (the line formed by the anterior edge of the spinous processes – extends from inner edge of skull) Bone – Trace the cortical outline of all the bones to check for fractures Note: The spinal cord (not visible) lies between the posterior and spinolaminar lines Disc spaces – The vertebral bodies are spaced apart by the intervertebral discs – not directly visible with X-rays. These spaces should be approximately equal in height Pre-vertebral soft tissue – Some fractures cause widening of the pre-vertebral soft tissue due to pre-vertebral haematoma Normal pre-vertebral soft tissue (asterisks) – narrow down to C4 and wider below Above C4 ≤ 1/3rd vertebral body width Below C4 ≤ 100% vertebral body width Note: Not all C-spine fractures are accompanied by pre-vertebral haematoma – lack of pre-vertebral soft tissue thickening should NOT be taken as reassuring Edge of image – Check other visible structures C-Spine normal anatomy – Lateral (detail) Bone – The cortical outline is not always well defined but forcing your eye around the edge of all the bones will help you identify fractures C2 Bone Ring – At C2 (Axis) the lateral masses viewed side on form a ring of corticated bone (ring) This ring is not complete in all subjects and may appear as a double ring A fracture is sometimes seen as a step in the ring outline C-Spine systematic approach – Normal AP Although often less informative than the lateral view, this view may nevertheless provide important corroborative information – a systematic approach is required. Coverage – The AP view should cover the whole C-spine and the upper thoracic spine Alignment – The lateral edges of the C-spine are aligned (lines) Bone – Fractures are often less clearly visible on this view than on the lateral Spacing – The spinous processes (orange) are in a straight line and spaced approximately evenly Soft tissues – Check for surgical emphysema Edges of image – Check for injury to the upper ribs and the lung apices for pneumothorax C-Spine normal anatomy – Open mouth view This view is considered adequate if it shows the alignment of the lateral processes of C1 and C2 (circles) The distance between the peg and the lateral masses of C1 (asterisks) should be equal on each side Note: In this image the odontoid peg is fully visible which is not often achievable in the context of trauma due to difficulty in patient positioning C-Spine normal anatomy – ‘ Swimmer’s’ view Oblique image with the humeral heads projected away from the C-spine The cervico-thoracic junction can be seen Check alignment by carefully matching the corners of each adjacent vertebral body – anteriorly and posteriorly A swimmer’s view may be useful in assessing alignment at the cervico-thoracic junction if C7/T1 has not been adequately viewed on the lateral image, or on a repeated lateral image with the shoulders lowered. C1 Fracture Results in loss of integrity of its ring structure. The ring expands and loses alignment with the adjacent occipital bone above, and C2 below. Most readily appreciated on the open mouth view which shows that the lateral masses of C1 no longer align with the lateral masses of C2, and that the spaces between the peg and the C1 lateral masses are widened. C1 ‘Jefferson’ fracture – Open mouth view The space between the odontoid peg of C2 and the lateral masses of C1 is widened on both sides (arrows) The lateral masses of C1 are both laterally displaced and no longer...

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