Cervical Spine Radiography Interpretation Lab Annie T. Sadosty, M.D. Department of Emergency Medicine Mayo Clinic, Rochester Who Needs a C-Spine X-ray? • Patients w/ Neck Trauma who: – – – – – have mid-line cervical tenderness have distracting injuries have focal neurologic deficits have mental status depression are intoxicated Hoffman et al, NEXUS Trial, NEJM 2000;343:94-9. Radiographic C-Spine Evaluation • Lateral • AP • Odontoid Normal Lateral C-Spine Normal AP C-Spine Odontoid View Approach to C-Spine X-ray Interpretation • Adequacy of film • Four lines – – – – Soft tissue ASL PSL SLL • A/O joint • • • • • • Odontoid Predental space Harris’ ring Vertebral bodies Facets Spinous processes 4 Lines C1-C2 Relationship Swimmer’s View Radiographic Unknowns Look at the following radiographs systematically and attempt to identify the injury. C1-C2 Relationship Odontoid Fractures Hangman’s Fracture Example Hyperflexion Strain Example Summary • C-Spine injuries are tricky. • Do not trust the exam of a drunk, demented or distracted individual. • When in doubt, image. • Keep the patient immobilized until you are certain there is not an injury. • Review the x-rays carefully and use a systematic approach to do so.