1. Managing Minor Musculoskeletal Injuries and Conditions First Edition. David Bradley. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/bradley/musculoskeletalwww.wiley.com/go/bradley/musculoskeletal

2. The cervical spine

3. Cervical Spine 1 An elderly patient having an X-ray because of severe pains in their neck and shoulder. No history of trauma. Is there anything to note? Study it carefully; when you are satisfied, see my comments on the next slide.

4. Cervical Spine 1 - my comments Lateral view of the cervical spine. Become completely confident at determining the level. I have numbered the vertebral bodies for you here. There are gross OA changes: Osteophytic lipping, especially on the anterior and posterior corners of the bodies of C4, 5 and 6 (some shown with small yellow arrows) Most disc spaces narrowed. Osteophytes on the bodies of C4 and C5 have fused anteriorly (thick yellow arrow). With cervical spine films, always be able to see the C7 T1 junction (white arrow). C2 C3 C1 C4 C5 C6 C7

5. Cervical Spine 2 Study this X-ray and then look at my comments on the following slide.

6. Cervical Spine 2 - my comments One check to be made on all cervical spine films is that the alignment of the vertebra is correct. Here we see that C4 has ridden forwards on C5. The anterior and posterior borders of the bodies are outlined in yellow. C4

7. Cervical Spine 3 This slide shows gross OA changes of the cervical vertebral column, with C4 and 5 bodies fused. Note that most bodies have lost their roughly rectangular shape, have lipping at the corners due to osteophyte formation and the disc spaces are bulging or narrowed.

8. Cervical Spine 4 A very straight neck - the cervical spine has lost its concave posteriorly curve. There is noticeable C5, 6 and 7 anterior lipping.

9. Cervical Spine 5 This film has lines drawn on to show the angle of the facet joints. Best if you actually handle bone or bone models now to fully appreciate the relationship. When you have it clear in your mind, look at the following slide, which shows the same on a paediatric patient.

10. Cervical Spine 6 Look at the much shallower angle of the facet joints on this paediatric patient.

11. Cervical Spine 7 Now this is a very important X- ray, one I have shown to many students over the years to get a valuable point over to them. Comment on it now; see if you can see a fracture, even if you have never been very good with skull X-rays; then look at the next slide.

12. Cervical Spine 7 - my comments If you noticed the patient’s problem, very well done - you will be one of the very few (a handful) who realised that the patient had no neck! The point of all this is that you must have a routine, an order, of what to look at when interpreting an X-ray. Unless you routinely look for problems, you will miss them.