1. CERVICAL SPINE
RTEC 124
WEEK 6
Rev 2010

4. Review the
anatomy

6. Direction of cervical zygapophyseal joints
seen in OBLIQUE
seen in LATERAL position

7. INTERVERTEBRAL FOREAMEN
AP = SIDE UP PA = SIDE DOWN

8. POSITIONING FOR CERVICAL SPINE
ROUTINE “5 views” (arthritis, etc)
AP “ODONTOID”
AP (axial)
BOTH OBLIQUES,
LATERAL (UPRIGHT)
SWIMMERS – LATERAL (if needed)
ROUTINE “2view”
AP (axial) , AP “ODONTOID”,
TRAUMA
CROSS TABLE LATERAL (minimum)
“ CLINICAL “ ROUTINE
“LATERAL (UPRIGHT)
pt is ↑ ┴ C/R
PT is ↑ or ↓
AP “ODONTOID” ┴
< C/R (15 – 20 º) ↑ (AP )
AP (axial)
BOTH OBLIQUES,
SWIMMERS – LATERAL
(if needed) pt is ↑ or ↓

9. Done supine or
upright

10. May be more difficult to do upright - use a sponge on back of head to relax neck muscles
May need to use a ┴
or C/R < 5º ↑
To move incisors off dens

13. Done supine or upright

17. LATERAL
C.SP

19. Some rotation ((zygo & pillars not s/i)
& TILT

21. C.SP OBLIQUES

24. With head in true lateral –
Look at the mandible position

25. With head in oblique –
Look at the mandible position

26. “SWIMMERS FOR C.SP
TWINNING
&
PAWLOW METHODS

28. Name of the position ?

29. C/R @ C7- T1
PERP OR ANGLED 5 CAUD

30. Alternate Positioning
FLEXION &
EXTENSION
Purpose?
Flexion and extension views should be obtained in awake and cooperative patients to further evaluate for injury. Flexion views will exaggerate the radiographic abnormalities and extension views will reduce them. Anterior subluxation & check for ROM

31. MML ┴ to IR MML // with CR Alternate Positioning Fuchs vs Judd
Demonstrates?
MML ┴ to IR
MML // with CR

33. AP oblique
atlanto-occipital joint.

35. BEST SEEN

37. SPINAL INJURY PT an overview : this will be covered in more detail in the TRAUMA lecture

38. “TRAUMA SERIES” SHOULD CONSIST OF 2 “views” /projections
90º TO EACH OTHER
MOVE C/R AND CASSETTE –
NOT THE PATIENT !!!
“TAKE IT AS IT LIES” “DO NOT HARM”

39.                                            
                         
                                           
                         
When the patient is a true “trauma” care must be taken not to move the patient
At a minimum the AP’s & laterals are done with the C.COLLAR in place
Then after CLEARED by the MD – you may proceed (?w/o? collar????? )
May be required to repeat AP & Lat again without collar artifact

40. X-TABLE LATERALS AKA ‘DORSAL DECUBITUS” CERVICAL SPINE
Can be done with or without a grid
With Comp Rad probably need a grid

41. X-table Lateral C. SP

42. Peds pt with comp Dis loc C-2 C-3
Pt died on table

43. For Odontoid in C collar

44. X-table lat –”Swimmers” Note: Mrs
X-table lat –”Swimmers” Note: Mrs. Charman’s tip : Place forearm on forehead to prevent superimposition of humerus + c.sp

46. Alternate “Trauma Views”
OBLIQUE – TRAUMA C.SP

47. Pathology Terms Neck pain HANGMANS FX Many causes including
Trauma MVA, sports, falls
degenerative disease
Infections
Neoplasms
congenital variations,
inflammatory arthritis
psychic tension
Etc………
HANGMANS FX
JEFFERSON FX
CLAY SHOVELER’S FX
SUBLUXATION
COMPRESSION FX
REVIEW PG # 388 Merrills

48. more pathology C. SP
Whiplash Injuries”
Passengers forewarned of an impending rear collision can potentially protect themselves by flexing the neck and tucking the chin against the chest. An extended head potentiates the risk of ligamentous rupture and articular dislocation. Areas of preexisting degenerative disease are most susceptible to injury.
radiculopathy- segmental motor or sensory signs associated with a root disorder. (numbness in hands/arms)
Tear drop fx
from Extreme flexion

49. Spinal Cord
C-1 ring fx

50. .AVULSION FX c-1
A fracture involving the entire anterior arch is unstable

51. A wedge fracture of a vertebra is caused by compression between two other vertebrae
Surgical repair
After subluxation or
Wedge fx

52. HANGMAN’S FX C.SP
The hangman´s fracture is located in the pedicles of C2, with C2 displacing anteriorly on C3

53. Jefferson’s fx
a burst fx of C-1 –atlas = results from compression of the C.SP – may also be associated with fx of C-2 (axis)
May or may not involve the transverse ligament

54. Jefferson fracture lateral displacement of lateral masses of C1 bilaterally (white lines).

56. Image Critique (Elsevier)

57. Image Critique (Elsevier)
Shoulders are not rotated away from the cervicothoracic region, preventing clear image of the spine.
There are two possible reasons: excessive rotation of the upper torso beyond a 45° oblique position or incorrect or inadequate CR angle angle

58. Excessive flexion excessive extension of neck

60. excessive flexion of neck
excessive extension of neck

62. Some rotation & Tilt

63. C 7 not seen
Use weights (5-10) lbs if possible
Expose on expiration

64. Not enough rotation to 45º
Position?
TOO much rotation (look at spinous
Process)
Looks like “AP”

65. Upper OK – lower - too much rotation of body (Done PA ) CR < wrong way

66. LAO
Head is lateral
Atlas & post arch obscured
Cortex of skull on s/I
Mandibles not s/I
1st Tsp not shown
(head tiled away from IR too much)
CR/IR too superior
Keep IP line ┴ to IR & move CR ↓

67. Some studies of spinal trauma have recorded a missed injury rate as high as 33%.

68. C1 c2 sublux c4 wedge fx

69. Fracture of the pedicles with dislocation of C5 and C6
Fracture of the pedicles with dislocation of C5 and C6. Note superior portion of C7 shown on this image.

70. Dislocation of the C3 and C4 articular processes
Note that C7 is not well demonstrated