C-Spine X-ray Checklist (Adults)
A.. Lateral c-spine - keep hard collar on.
- adequacy of film - see all of C7, top of T1. If "No" -
continue
anyway. Repeat films if no fracture.
- Alignment -
Fig. 1 - line 1 -
continues along ant. odontoid
- Line 2 - continues along posterior odontoid
- Line 3 – connects laminae
-
Line 4 note C1 should not reach
this line
-
Soft tissue thickness < 5 mm at C2 and <20 mm at C6 Fig. 7
- Atlanto-odontoid space: 3 mm or less Fig. 6
-
Bones - check for fractures. Shape of C3-C7 vertebral
body should be approx. the same as the one
above and below.
- Alignment – Anterior subluxation of C2 on C3 indicates
Hangman’s fracture. This is a bilateral
pars fracture from forced hyperextension Fig 8.
If a fracture is seen - do no further views -
immobilize and transfer
B. If lateral is normal, remove
immobilization and proceed with more views
Odontoid view: Fig. 2
- Alignment of lateral masses (arrows)
-
Odontoid fracture - 3 types shown
-
Jefferson (Burst type) fracture will show on this view. >2mm bilateral offset of C1
Relative to C2 is always abnormal Fig. 9
PA view: Fig. 4
- Alignment
of spinous processes only
-
Malalignment implies fracture or facet dislocation Fig.5
C. Obliques -Useful for unilateral facet dislocations -Foraminae all intact Fig.3
- Laminae line up like"shingles on a roof"
- Asymmetrical in case of
unilateral facet dislocation
D. Flexion-extension views -for further
reassurance if other views normal. These are best supervised by a Radiologist.
Source:
Stobbe,
Karl. Can j Rural Med 2004; 9 (1)
Canadian
Society of Rural Physicians Critical Care Module: C-spine X-Ray Interpretation
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