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PEM Ortho X-ray Curriculum

General Considerations

x-rays showing a normal C-spine
FIGURE 1: Normal C-spine x-ray

 

  • An adequate C-spine series includes a minimum of 3 views (FIGURE 1)
    • True lateral (ensure C1 through C7 are included as well as the C7-T1 junction)
    • AP view (of C3 through C7)
    • Open mouth odontoid view (of C1-C2)
      • Difficult to obtain in children < 8 years old
  • Certain views may be needed for further evaluation of the C-spine
    • Flexion-extension views
      • To evaluate ligamentous injuries
    • Swimmer's view
      • To better visualize C7 and T1

              

                        FIGURE 2: Normal C-spine Anatomy                     FIGURE 3: Normal lateral C-spine x-ray

  • Systematic Approach to Interpretation of Paediatric C-spine x-rays
    • The ABCS method is a useful approach (FIGURE 2 & FIGURE 3)
      • A II seven vertebrae
      • A tlantodental interval (pre-dens space) < 5 mm
      • Alignment
        • Lordotic curves
        • Gross malalignment
        • Subluxation
        • Distraction
      • Bones
        • Fractures
        • Anterior and posterior vertebral columns
        • Ossification centers
      • Cartilage
        • Intervertebral disc spaces
        • Ossification centers
      • Soft tissues
        • Prevertebral disc space
          • C1-C3 < 1/2 width of adjacent vertebral body
          • C4-C7 < width of adjacent vertebral body
    • Four contour lines of alignment are seen with normal C-spine lordosis
      1. 1. Anterior vertebral bodies (anterior marginal or vertebral line)
      2. 2. Posterior vertebral bodies or anterior spinal canal (posterior marginal vertebral or cervical line)
      3. 3. Posterior spinal canal (spinolaminar or spinothamalamic line)
      4. 4. Spinous process tips (posterior spinous line)