Approach to C-Spine X

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
• Adequacy of film
• Four lines
Soft tissue
• A/O joint
Predental space
Harris’ ring
Vertebral bodies
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
• 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.

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