![]() ![]() Assessment requires a systematic approach. The lateral view is often the most informative image. If the lateral view does not show the vertebrae down to T1 then a repeat view with the arms lowered or a ' Swimmer's view' may be required. In the context of trauma these images are all difficult to acquire because the patient may be in pain, confused, unconscious, or unable to cooperate due to the immobilisation devices. The 3 standard views are - Lateral view - Anterior-Posterior (AP) view - and the Odontoid Peg view (or Open Mouth view). ![]() Imaging should not delay resuscitation.įurther imaging with CT or MRI (not discussed) is often appropriate in the context of a high risk injury, neurological deficit, limited clinical examination, or where there are unclear X-ray findings. This is because normal C-spine X-rays cannot exclude significant injury, and because a missed C-spine fracture can lead to death, or life long neurological deficit.Ĭlinico-radiological assessment of spinal injuries should be managed by experienced clinicians in accordance with local and national clinical guidelines. Bones - Cortical outline/Vertebral body heightĬlinical considerations are particularly important in the context of Cervical spine (C-spine) injury.Alignment - Anterior/Posterior/Spinolaminar.Look at all views available in a systematic manner.Clinical considerations are of particular importance when assessing appearances of C-spine X-rays.Normal C-spine X-rays do not exclude significant injury.It’s often helpful to align one plane at a time as in the example above. When setting up the procedure, the initial imaging can look very messy. A slight tilt in that plane alone will fix this misalignment. Discussion: - demonstrates primarily neural foramina, pedicles, articular masses, apophyseal joints, & relative relationship at lamina - oblique views show the pedicle in profile, and also allows assesment of the intervertebral foramina (and osteophytes encroaching.Ossification of the posterior longitudinal ligament: a review of literature. This means that your x-ray beam isn’t in a perfect frontal plane. This online presentation reviews a variety of cervical spine entities, with case examples and illustrations to clarify concepts, and discusses differential considerations and potential diagnostic pitfalls.The vertical lines are the posterior border of the lateral masses.You can see the green and yellow lines are mostly misaligned vertically.They aren’t aligned and hence the image isn’t a perfect lateral. Yellow outlines the same border on the other side. Green outlines the posterior border of the lateral mass on one side. Compare to a version with outlines along the posterior borders of the lateral masses. If this were the fluoro image it would generally be workable, but it isn’t perfect.Ĭ3 and C4 are the most obvious examples of slight misalignment.Troubleshooting Imagesīelow is an example from the cervical medial branch block guide outlining our targets. This minimizes motion of the c-arm so it’s easy to re-establish your lateral view if needed. Generally well aligned lateral view that’s sufficient for procedures Source: C-Arm PositioningĪfter obtaining a good lateral view simply rotate the c-arm in one axis to get the AP view. Line up the borders of the lateral mass/articulating column so you don’t see “double images” when the left and right are out of alignment.Most work (medial branch blocks, epidurals, radiofrequency ablations) is done in the lateral or oblique view (as opposed to an AP view, which is more important for lumbar/thoracic work).All of this can be taped up after positioning. Have patients wear a bouffant with hair tied inside.Normally, the cervical spine has a slight anterior curvature (lordosis). This pulls down some of the pannus out of the way. Technical Factors: Image receptor size - two 30 x 35 cm or (11 x 14 inches), lengthwise or 24 x 30 cm (10 x 12 inches) Moving or stationary grid 75 to 85 kV range (or 85 to 90 kV and reduction of mAs and dose. As seen on the lateral cervical spine radiograph (right), the normal cervical spine consists of seven cervical vertebral bodies and supporting ligaments.If the patient is in a prone position you can tape back pannus: apply tape near the base of the neck and pull down a long strip towards the low back (ie following the spine). The student will take radiographs on phantom anatomical parts with the.Obese patients often have fat that limits access to the injection site or obscures the image.Try to have the shoulders pulled down slightly and/or curled forward to get them out of the way.Hunched shoulders can obscure the lower levels of the neck in a lateral view.Avoid flexion, except CESIs where you want the head flexed on the neck.A twisted neck can make lateral and AP views misaligned.Try to position the patient so the neck is in a “long”, neutral position. ![]()
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