Lateral view of cervical spine x ray3/24/2024 Such lesions that leave the trapezius muscle unopposed occur in the lower cervical region. The C7-Th1 vertebrae may be obscured in muscular or obese patients (Figure2), or in patients with spinal cord lesions that affect the muscles which normally depress shoulders. Only c-spine radiograph one should be satisfied with is the one showing all of the 7 cervical vertebrae (C1-Th1).Most spinal injuries occur at the junctions of the spine: craniocervical, cervicothoracic, thoracolumbar and lumbosacral.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. horizontal beam imaging can produce unwanted image artefact.By Dejvid Ahmetović and Gregor Prosen IntroductionĬ-spine x-ray interpretation is one of the fundamental skills of emergency physicians.exaggerated thoracic kyphosis can mean the field of view is wide and can include the majority of the anterior thorax be aware of this when collimating and choosing the coronal centering point.the three-column concept of thoracolumbar spinal fractures is of particular importance when assessing this image for pathology.If clinical concern for injury in this area is strong, the cervical spine: swimmer's lateral view can be included, or referral to CT can be made visualization of the upper thoracic spine is often difficult given the patient thickness at this region.adequate image penetration and image contrast is evident by clear visualization of thoracic vertebral bodies, with both trabecular and cortical bone demonstrated.intervertebral joints and neural foramen are open, with the superimposition of the posterior spinous processes and posterior rib articulation indicating a true lateral has been achieved.The entire thoracic spine should be visible from T1 to T12: yes (ensure the correct grid is selected if using focussed grids).anterior and posterior to include the anterior margin of all thoracic vertebrae and posterior to include the posterior column elements.inferiorly to include the T12/L1 junction.superiorly to include the C7/T1 junction.the central ray is perpendicular to the image receptor.the level of the 7th thoracic vertebra, which correlates to the inferior border of the scapula, centered directly over the thoracic spine (most commonly equates to the posterior third of the thorax).suspended expiration (or breathing technique if possible).in all variations of positioning, the humeri are extended 90º to the thorax, with the elbows flexed so that the forearms are parallel to the thorax.the lateral projection requires the upper limbs to be removed from the path of the direct x-ray beam, minimizing the superimposition of the proximal humeri over the thoracic vertebrae.all imaging of patients with a suspected spinal injury must occur in the supine position without moving the patient.ideally, spinal imaging should be taken erect in the setting of non-trauma to give a functional overview of the thoracic spine.the patient is erect, supine or lateral decubitus depending on clinical history. It can help to visualize any compression fractures, subluxation or kyphosis, and is used in conjunction with the AP view to complete a thoracic spine series. This projection is utilized in many imaging contexts including trauma, postoperatively, and for chronic conditions.
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