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C-Spine Plain Films
Mike Rissing
Associate Student of Clinical
Medicine
Outline
Epidemiology
Indications for C-spine imaging
Modalities
 Interpretation
Types of fractures
Epidemiology
7000-10000 c-spine injuries treated each
year
Additional 5000 die at the scene
Mean age is 30.7, Mode is 1...
Indications for C-spine Films
Tenderness
Neurologic defecit
Forceful Mechanism of injury
Distracting injury
Altered s...
Modalities
Plain films – Lateral, AP, and Odontoid
CT
MRI
Interpretation of Lateral Plain Film
Mnemonic AABCS
Adequacy
Alignment
Bones
Cartilage
Soft Tissue
Interpreting Lateral Plain Film
Adequacy
Should see C7-T1
junction
If not get swimmer’s
view or CT
Swimmer’s View
Interpreting lateral Plain Film
Alignment
Anterior vertebral line
Formed by anterior borders of vertebral bodies
Poste...
Alignment
Bones
Cartilage
Predental Space
should be no more
than 3 mm in adults
and 5 mm in children
Increased distance
may indicate fra...
Cartilage Cont.
Disc Spaces
Should be uniform
Assess spaces
between the spinous
processes
Soft tissue
 Nasopharyngeal
space (C1) - 10 mm
(adult)
 Retropharyngeal
space (C2-C4) - 5-7
mm
 Retrotracheal space
(C5...
AP C-spine films
Spinous processes
should line up.
Disc space should be
uniform
Vertebral body
height should be
uniform...
Odontoid view
Adequacy: all of the
dens and lateral
borders of C1 & C2
Alignment: lateral
masses of C1 and C2
Bone: Ins...
Fractures
Mechanisms of injury
hyperflexion i.e.
diving in shallow
water
axial compression i.e.
landing directly on
hea...
Fractures
Classified as stable or unstable
Stability of cervical spine is provided by two
functional vertical columns
A...
Fractures
 Jefferson Fracture
 Compression fracture of
C1 ring
 Most common C1 fracture
 Unstable
 Commonly see incre...
Fractures
Fractures
Burst Fracture
Fracture of C3-C7
from axial loadinng
Spinal cord injury is
common from
posterior
displacement...
Fractures
Clay Shoveler’s
Fracture
Flexion fracture of
spinous process
C7>C6>T1
stable
Flexion Teardrop
fracture
Flexion injury
causing a fracture of
the anteroinferior
portion of the
vertebral body
Unstabl...
Fractures
 Bilateral Facet
Dislocation
 Flexion injury
 Subluxation of dislocated
vertebra of greater than
½ the AP dia...
Fractures
Hangman’s Fracture
Extension injury
Bilateral fractures of
C2 pedicles (white
arrow)
Anterior dislocation
of...
Fractures
Odontoid
Complex mechanism of injury
Generally unstable
Type 1 fracture through the tip
rare
Type 2 fractu...
Summary
Know when to order C-spine films:
tenderness, forceful injury, altered
sensorium, distracting injury, neurologic
...
C-Spine Plain Films
C-Spine Plain Films
C-Spine Plain Films
C-Spine Plain Films
C-Spine Plain Films
C-Spine Plain Films
C-Spine Plain Films
C-Spine Plain Films
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Transcript of "C-Spine Plain Films"

  1. 1. C-Spine Plain Films Mike Rissing Associate Student of Clinical Medicine
  2. 2. Outline Epidemiology Indications for C-spine imaging Modalities  Interpretation Types of fractures
  3. 3. Epidemiology 7000-10000 c-spine injuries treated each year Additional 5000 die at the scene Mean age is 30.7, Mode is 19 82% males 50% MVC, 25% Falls, 10% Sports * www.med-ed.virginia.edu/courses/rad/cspine/index.html
  4. 4. Indications for C-spine Films Tenderness Neurologic defecit Forceful Mechanism of injury Distracting injury Altered sensorium
  5. 5. Modalities Plain films – Lateral, AP, and Odontoid CT MRI
  6. 6. Interpretation of Lateral Plain Film Mnemonic AABCS Adequacy Alignment Bones Cartilage Soft Tissue
  7. 7. Interpreting Lateral Plain Film Adequacy Should see C7-T1 junction If not get swimmer’s view or CT
  8. 8. Swimmer’s View
  9. 9. Interpreting lateral Plain Film Alignment Anterior vertebral line Formed by anterior borders of vertebral bodies Posterior vertebral line Formed by posterior borders of vertebral bodies Spino-laminar Line Formed by the junction of the spinous processes and the laminae Posterior Spinous Line Formed by posterior aspect of the spinous processes
  10. 10. Alignment
  11. 11. Bones
  12. 12. Cartilage Predental Space should be no more than 3 mm in adults and 5 mm in children Increased distance may indicate fracture of odontoid or transverse ligament injury
  13. 13. Cartilage Cont. Disc Spaces Should be uniform Assess spaces between the spinous processes
  14. 14. Soft tissue  Nasopharyngeal space (C1) - 10 mm (adult)  Retropharyngeal space (C2-C4) - 5-7 mm  Retrotracheal space (C5-C7) - 14 mm (children), 22 mm (adults)  Extremely variable and nonspecific
  15. 15. AP C-spine films Spinous processes should line up. Disc space should be uniform Vertebral body height should be uniform. Check for oblique fractures.
  16. 16. Odontoid view Adequacy: all of the dens and lateral borders of C1 & C2 Alignment: lateral masses of C1 and C2 Bone: Inspect dens for lucent fracture lines
  17. 17. Fractures Mechanisms of injury hyperflexion i.e. diving in shallow water axial compression i.e. landing directly on head Hyperextension i.e. hitting dashboard in MVC
  18. 18. Fractures Classified as stable or unstable Stability of cervical spine is provided by two functional vertical columns Anterior column: vertebral bodies, the disc spaces, the anterior and posterior longitudinal ligaments and annulus fibrosus Posterior column: pedicles, facets and apophyseal joints, laminar spinous processes and the posterior ligament complex As long as one column is intact the injury is stable.
  19. 19. Fractures  Jefferson Fracture  Compression fracture of C1 ring  Most common C1 fracture  Unstable  Commonly see increase in predental space on lateral if transverse ligament is damaged and displacement of C1 lateral masses on odontoid.  Obtain CT
  20. 20. Fractures
  21. 21. Fractures Burst Fracture Fracture of C3-C7 from axial loadinng Spinal cord injury is common from posterior displacement of fragments Stable if ligaments intact
  22. 22. Fractures Clay Shoveler’s Fracture Flexion fracture of spinous process C7>C6>T1 stable
  23. 23. Flexion Teardrop fracture Flexion injury causing a fracture of the anteroinferior portion of the vertebral body Unstable because usually associated with ligamentous injury
  24. 24. Fractures  Bilateral Facet Dislocation  Flexion injury  Subluxation of dislocated vertebra of greater than ½ the AP diameter of the vertebral body below it  High incidence of spinal cord injury  Extremely unstable
  25. 25. Fractures Hangman’s Fracture Extension injury Bilateral fractures of C2 pedicles (white arrow) Anterior dislocation of C2 vertebral body secondary to ALL tear (red arrow) Unstable
  26. 26. Fractures Odontoid Complex mechanism of injury Generally unstable Type 1 fracture through the tip rare Type 2 fracture through the base Most common Type 3 fracture through the base and body of axis Best prognosis
  27. 27. Summary Know when to order C-spine films: tenderness, forceful injury, altered sensorium, distracting injury, neurologic deficit Remember your AABC’S Order CT for evaluation of extent of fracture or MRI if suspect soft tissue injury
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