There’s nothing like a C-spine film to strike fear into an uninitiated orthopaedic clerk…or intern or resident! Hare are a few guidelines to help you survive the C-spine experience!

Views:

3 Basic views: Lateral, AP, Odontoid (open mouth)
(note: in a trauma situation the lateral is considered the essential first view along with an AP of the chest and pelvis)

The Lateral:

CAN YOU SEE C1-T1 ?

• If not then film is inadequate.
• Alignment: Anterior body, posterior body, facet joints, laminar fusion line.
• Bones: Check individual vertebrae one at a time for deformity eg. Compression
• Soft Tissue: Look for localized swelling in the prevertebral soft tissue.
  • C2 – 7 mm
  • C5 – 22mm
  • Atlanto-Dens Interval: MAX 3mm in adult.

The AP:

• Not as useful as the lateral but can provide some useful clues.
• Check alignment of the spines in the midline.
• Look for loss of height of the bodies or widening of the pedicles.

The Odontoid:

• Hard to get a good one! Useful for odontoid fractures and C1 Jefferson fractures.

Swimmers View:

• Often required if the lateral does not show C7-T1.
• Can try pulling down on both arms and repeating the lateral. If not then pull one arm up and above the head and one down to the feet and repeat lateral.

Clearing C-Spines

If the patient is fully conscious (includes no alcohol/drugs), has normal AP, Lateral and Odontoid X-rays AND has a full pain-free range of motion then the C-spines can be cleared.

Suspect C-spine fracture in any head injury!


Even a CT scan may miss a ligamentous disruption. Therefore the C-Spines cannot confidently be completely cleared in the unconscious patient.

Attachments:

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