Continued (D) With this view, the five contour lines of the normal cervical spine can be demonstrated: anterior vertebral line drawn along anterior margins of the vertebral bodies posterior vertebral line (outlines anterior margin of spinal canal), drawn along posterior margins of the vertebral bodies spinolaminar line (outlines posterior margin of the spinal canal), drawn along the anterior margins of the bases of the spinous processes at the junction with lamina posterior spinous line drawn along the tips of the spinous processes from C2-7, which should be running smoothly, without angulation or interruption and the clivus-odontoid line, drawn from the dorsum sellae along the clivus to the anterior margin of the foramen magnum should point to the tip of the odontoid process at the junction of the anterior and middle thirds. Fluoroscopy and videotaping are usually of little help in acute injuries because pain may prevent the necessary movement for positioning.įIGURE 11.3 Lateral view. 11.13) may be used for better demonstration of the C7, T1, and T2 vertebrae, which on the standard lateral or oblique projection are obscured by the overlapping clavicle and soft tissues of the shoulder girdle. 11.12), which may be obtained in the anteroposterior or oblique projection, serves to demonstrate the lateral masses of the cervical vertebrae, and the swimmer’s view ( Fig. Special projections may occasionally be required for sufficient evaluation of the structures of the cervical spine. 11.11) are not routinely obtained, although at times they help visualize obscure fractures of the neural arch and abnormalities of the neural foramina and apophyseal joints. Oblique projections of the cervical spine ( Fig. Visualized, particularly its upper half, then the Fuchs view may be helpful ( Fig. If the open-mouth view is difficult to obtain or the odontoid process is not clearly The body of C2 is clearly imaged, as are the atlantoaxial joints, the odontoid process, and the lateral spaces between the odontoid process and the articular pillars of C1. This view provides effective visualization of the structures of the first two cervical vertebrae. 11.9) may also be obtained as part of the standard examination. A variant of the anteroposterior projection known as the open-mouth view ( Fig. The spinous processes are seen almost on end, casting oval shadows resembling teardrops. 11.8), the bodies of the C3-7 vertebrae (and occasionally in young persons, even the C1 and C2 vertebrae) are well demonstrated, as are the uncovertebral (Luschka) joints and the intervertebral disk spaces. On the anteroposterior view of the cervical spine ( Fig. It is of the utmost importance on the lateral projection of the cervical spine that the C7 vertebra be visualized, because this is the most commonly overlooked site of injuries. The lateral radiograph may also be obtained in flexion of the neck, which is particularly effective in demonstrating suspected instability at C1-2 by allowing evaluation of the atlanto-odontoid distance an increase in this distance to more than 3 mm indicates atlantoaxial subluxation. ![]() The bodies and spinous processes of C2-7 are fully visualized, and the intervertebral disk spaces and prevertebral soft tissues can be adequately evaluated. This projection suffices to demonstrate most traumatic conditions of the cervical spine, including injuries involving the anterior and posterior arches of C1 the odontoid process, which is seen in profile and the anterior atlantal-dens interval. The single most valuable projection in these instances is the lateral view, which may be obtained in the standard fashion or with the patient supine, depending on the condition ( Fig. Radiographic examination of a patient with cervical spine trauma may be difficult and is usually limited to one or two projections because frequently the patient is unconscious, there are associated injuries, and unnecessary movement risks damage to the cervical cord.
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