Spine Radiography

Dorn Spinal Therapy

Spine Healing Therapy

Get Instant Access

A lateral cervical radiograph should be obtained in the ER and will demonstrate most vertebral subluxations and facet dislocations, as well as many fractures. A complete cervical spine series in preadolescent children includes a lateral radiograph extending from the occiput to at least the cranial portion of the T1 vertebral body and an AP radiograph. In adolescents and adults, an open-mouth radiograph of the odontoid process should also be obtained. 'Tandem' cervical and thoracolumbar-sacral (TLS) injuries are not uncommon, particularly after a motor-vehicle accident (MVA).

The lateral cervical radiograph should be used to evaluate the alignment of the anterior edge of the vertebral bodies, posterior edge of the vertebral bodies, the

Figure 7. Lateral cervical radiographs in flexed and extended positions. Dynamic cervical radiographs may be useful in cervical-spine clearance after trauma but should not be undertaken in the presence of known fracture, instability, neck pain or neurological deficit. Limited flexion or extension due to poor cooperation or splinting, as seen here, can also limit the value of the examination.

Figure 7. Lateral cervical radiographs in flexed and extended positions. Dynamic cervical radiographs may be useful in cervical-spine clearance after trauma but should not be undertaken in the presence of known fracture, instability, neck pain or neurological deficit. Limited flexion or extension due to poor cooperation or splinting, as seen here, can also limit the value of the examination.

anterior edge of the laminae and the tips of the spinous processes. Splaying apart of adjacent spinous processes is a sign of ligamentous injury and possible instability. Fracture, deformity or asymmetry of any vertebral body or spinous process should be noted. Facet-joint widening or distraction may be apparent. Finally, the width of prevertebral soft tissue should be evaluated. In some cases, abnormal swelling of prevertebral soft tissue is the only radiographic sign of significant spinal-column ligamentous injury and instability.

The AP view should be evaluated for open or dislocated facets, alignment and vertebral deformity. The open-mouth view, if available, should be evaluated for fractures of the odontoid or for splaying of the lateral masses of C1 ( >7mm combined), both of which are signs of C1-2 instability.

If all static spine radiographs, as listed above, are negative for fracture, subluxation or other abnormality, the neurological examination is normal, and the spine is nontender at rest and during voluntary cervical flexion and extension, a significant spine injury may be excluded. However, many children with distracting painful injury, intoxication or head injury, or of preverbal age cannot accurately report spine tenderness. Performance of flexion and extension spine radiographs (see Fig. 7) may expose these patients to risk of further mechanical spinal-cord injury. In these cases, static MR imaging may be helpful in diagnosing unrecognized spinal instability.

Was this article helpful?

0 0

Post a comment