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Subject: Lateral C-Spine X-ray
Date: Thu, 27 Jan 2005 10:24:45 +0800
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Lateral C-Spine X-ray
C-Spine =
X-ray=20
A : Adequacy and alignment =
:
- Adequacy:=20
- Skull base-T1=20
- Swimmer's view=20
- Alignment:-- The 4 lordotic=20
lines:
- Anterior spinal =
line.=20
- Posterior spinal =
line.=20
- Spinolaminal line.=20
- Spinous process =
tips.=20
- Alignment:-- =
Subluxation:=20
- Paravertebral lines offset =
>/=3D 3.5=20
mm.=20
- Angulation >/=3D 11 =
degrees.=20
- Alignment:-- =
Pseudosubluxation=20
(physiologic subluxation):=20
- Posterior cervical line of =
Swischuck:=20
Offset </=3D 1.5-2 mm.=20
- Age </=3D15 y/o.=20
** Spinal canal =
diameter </=3D=20
13 mm (actually </=3D 9.3 mm)
B : Bones
C : Cartilage
- Synchondroses (odontoid, =
</=3D=20
6y/o).=20
- Growth plates / =
centers.=20
- IV disks.
S : Soft tissue
Prevertebral soft =
tissues (if=20
< 2 y/o, expiratory phase films not reliable):=20
| Level |
Adults |
Children |
| C2 |
</=3D 7 mm |
</=3D 7 mm |
| C3/4 |
</=3D 5 mm |
</=3D 7 mm (</=3D 50% VB) |
| C6 |
</=3D 22 mm |
</=3D 15 mm (</=3D 100% VB) |
Predental space:=20
| Adults |
</=3D 3 mm |
| Children (</=3D 8 y/o) |
</=3D 5 mm (no neurologic signs if < 7-10=20
mm) |
Components of=20
C-spine=20
- Vertebral body.=20
- IV disk.=20
- Ligaments. =
- Posterior =
components=20
- Lamina.=20
- Pedicles.=20
- Neural foramen.=20
- Facet joints.=20
- Spinous process.=20
- Ligaments.=20
Types of=20
c-spine injuries=20
- Axial loading.=20
- Flexion.=20
- Extension.=20
- Rotation.=20
- Lateral bending.=20
- Distraction. =
C-1 (atlas)=20
fractures=20
- Blowout of the ring =
(Jefferson=20
fracture) due to axial loading.=20
- Open-mouth (odontoid) =
view.=20
- Lateral offset of C1 lateral =
masses=20
> 1mm from C2 vertebral body.=20
- False positive if neck =
rotation.=20
- 1/3 associated with C-2=20
fracture.=20
- Usually not associated with =
cord=20
injury, but extremely unstable.
Pseudo-Jefferson=20
fracture=20
- 90% (+) at 2 y/o.=20
- Increased growth of C1 as =
compared to=20
C2 and radiolucent cartilage.=20
- Normalizes by 4-6 y/o. =
- CT scan needed to elucidate =
suspected=20
injury if < 4 y/o.
C-1 rotary=20
subluxation=20
- Open-mouth (odontoid) =
view.=20
- Odontoid not equidistant from =
lateral=20
masses; CT most useful.=20
- Most often seen in =
children.=20
- Torticolis (chin pointing to =
uninvolved=20
side).=20
- Unstable.=20
- Immobilize in place and refer =
to=20
definitive care.
C-2 odontoid subluxation=20
- Due to ruptured transverse =
ligament or=20
odontoid fractures.=20
- Prendental space > 3mm (or =
> 5 mm=20
in children). Symptomatic if > 7-10 mm.=20
- Steel=A1=A6s =A1=A7Rule of =
Three=A1=A8 : Odontoid =A1V=20
free space =A1V cord.=20
- Unstable.=20
C2 =
odontoid=20
fractures=20
- Type I : Avulsion of tip.=20
Stable.=20
- Type II : At the base. =
Unstable. (??=20
synchrondosis if < 6Y).=20
- Type III : Extends into =
vertebral body.=20
Unstable.
Posterior element fracture of C-2=20
- Hangman=A1=A6s fracture / =
traumatic=20
spondylolisthesis of C2.=20
- Mechanism : Extension + =
distraction or=20
Extension + axial compression.=20
- Unstable.=20
- Cervical traction=20
contraindicated.=20
- Anterior subluxation of C2 on =
C3=20
(=A1=A7Posterior cervical line of Swischuk=A1=A8 > 1.5-2 mm) must =
not be confused=20
with pseudosubluxation (< 8-16Y).
C-3 =
through C-7=20
injuries=20
- C-3 prevertebral soft tissue =
: < 5=20
mm (< 2/3 vertebral body in children).=20
- C-5 prevertebral soft tissue =
: < 15=20
mm.=20
- Clay shoveler=A1=A6s fracture =
:=20
Stable.=20
- Unstable if : =
- Disruption of anterior and =
all=20
posterior elements.=20
- Overriding of superior =
vertebra by >=20
3 mm.=20
- Angulation between 2 =
adjoining=20
vertebrae > 11 deg.
Facet=20
dislocation=20
- Unilateral (UFD) : Stable; =
25%=20
displacement.=20
- Bilateral (BFD) : Unstable; =
> 50%=20
displacement.
Teardrop fractures=20
- Extension teardrop : Stable =
in flexion,=20
unstable in extension.=20
- Flexion teardrop : Extremely=20
unstable.
Bursting fracture of vertebral body=20
- Stable.=20
- Spinal cord injury can occur =
(even=20
total transection).
Distraction=20
injuries=20
- Due to longitudinal stress =
(e.g.=20
difficult NB delivery).=20
- Increased space between =
occiput and=20
C1.=20
- Widening of IV disk without =
adjacent=20
compression fracture.=20
- MRI indicated if plain films=20
nonrevealing.
SCIWORA=20
- 67% of children with C-cord=20
injuries.=20
- Mainly < 8 Y.=20
- Plain films or tomograms =
(-).=20
- Etiology :
- Vascular injuries =
(occlusion, spasm,=20
infarction).=20
- Ligamentous injury.=20
- Disc impingement.=20
- Incomplete neuronal=20
destruction.
- May have transient neurologic =
symptoms=20
and apparently recover then return 1d later with significant =
neurologic=20
abnormalities.
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