Spinal Trauma Investigations

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STRAIGHT X-RAYS

lateral view

In the cervical spine: - note evidence of soft tissue swelling between the pharynx and the vertebrae.

- ensure C6 and C7 are included in the film. If not, repeat with gentle downward arm traction, or do a CT scan anteroposterior view

- note the alignment of the spinous processes and the width of the apophyseal joints and look for vertical ^ fracture lines.

- ensure C6 and C7 are included in the film. If not, repeat with gentle downward arm traction, or do a CT scan

- note any malalignment of the anterior or posterior margins of the vertebral body or of the lamina, i.e. subluxation.

- note any undue widening of the interspinous distance or of the disc space.

- note damage to the vertebral body, apophyseal joints, lamina or spinous process, e.g. anterior wedge collapse, 'burst'

fracture. the uPPer thoracic spine only Tomography may satisfactorily demonstrate the lateral view.

antero-posterior •open mouth' view

- may be required to demonstrate a fracture of the odontoid peg.

cervical spine

Disruption of the foraminal outline suggests malalignment

If doubt remains -

take oblique views to demonstrate the intervertebral foramina.

cervical spine

Disruption of the foraminal outline suggests malalignment

-- In the lumbar spine look for the normal 'scotty dog' appearance - if misshapen, suggests a fracture/dislocation.

If in doubt about cervical stability, take flexion/extension views, but only with expert supervision.

CT scanning may aid identification of a fracture and show fragments extending into the spinal canal. CT/myelography or MRI may provide additional information, but these investigations only help if operative decompression and/or stabilisation is considered.

-- In the lumbar spine look for the normal 'scotty dog' appearance - if misshapen, suggests a fracture/dislocation.

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