![]() ![]() Before analyzing cervical radiographs, some additional facts need to be presented.All of the three essential above mentioned projections can be seen in Figure 1.įigure 1: Lateral view with normal slight lordosis (A), Odontoid or open mouth view of the atlas and axis (B), Standard anteroposterior or AP view with open mouth, it can also be taken with closed mouth (C). Addition of the anteroposterior (AP) projection increases sensitivity to approximately 100%. The risk of missing a significant fracture is, according to statistics, less than 1%. Plain radiographs, when they show the lateral projection of the cervical spine and include an open mouth view, are fairly sensitive in identifying c-spine fractures. A more systematic approach to reading cervical radiographs can significantly reduce the chances of missing an important injury. Interpretation of radiographs has its limitations, which more or less depending on the individual’s knowledge of anatomy and clinical experience.īecause anatomical landmarks for measurements can sometimes be difficult to find or identify. Therefore, this chapter will summarize the basics of c-spine x-ray interpretation. Although current guidelines lead us to use CT scan for a suspected c-spine injury, c-spine x-rays are still valuable in some low resource settings and patient groups who are susceptible to radiation. ![]() This allows for discrepancies in the tilt of the head (flexion/extension of the cervical spine).By Dejvid Ahmetović and Gregor Prosen IntroductionĬ-spine x-ray interpretation is one of the fundamental skills of emergency physicians. To achieve the best angle, the central ray should be directed at an angle that parallels the plane of the mandible and then directed to just below the hyoid bone. An excessive or insufficient angle can distort these disc spaces. To project the intervertebral disc spaces open, the central ray should be directed perpendicular to the long axis of the vertebral column 3, 4. This angle can and will vary between 5-20° depending on the position of the head. For this reason, a cephalic angle is required to project through the long axis of the vertebral column. Correcting tube angle errors and head tilt errorsĪ lordotic curvature exists in the cervical spine. The spinous process will rotate toward the pedicle of the side farther from the image receptor 3. The spinous process should be midline of the vertebral body, equidistant from both pedicles 3. Any deviation from the midline indicates rotation is present. Rotation can be detected by looking at the spinous processes in relation to the pedicles.
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