Cervical Spine (Standard series) Flashcards
What does the standard Cx series consist of?
Neutral lateral.
AP lower cervical (APLC).
APOM (AP open mouth).
What does the marker indicate in a lateral Cx shot?
It indicates which shoulder is closest to the film.
In a lateral cervical, what are the 5 cervical lines that need to be assessed?
Pre-vertebral tissue soft tissue line Anterior vertebral bodies Posterior vertebral body line Spinolaminar junction line Spinous process interspaces
What is the rule of 2’s and 6’s?
At C2 < 6 mm
At C6 < 22 mm
What are the landmarks for the posterior vert body line?
Superior and inferior body corners.
What is the atlantodental interspace?
How big should the space be?
It’s the space between the posterior aspect of C1 anterior tubercle and the anterior aspect of odontoid process.
Adults: < 3 mm
Children: < 5 mm
What is McGregor’s Line?
Posterior-superior margin of hard palate to inferior-most surface of the occiput.
Tip of dens should be < 10 mm above McGregor’s Line.
What air shadows will be observed in a lateral cervical?
Pharyngeal
Laryngeal
Tracheal
What structures are visualized on an AP Lower Cx?
C3-C7 vertebral bodies.
Posterior elements (SPs and articular pillars are most consistent, other structures are more oblique).
Uncinate processes of uncovertebral joint spaces.
Soft tissues of neck.
What is laryngeal constriction?
Narrow when patient is holding their breath, open when patient is breathing.
What would make lateral margins on an AP lower Cx more difficult to visualize?
Superimposition of posterior elements.
On an AP lower Cx, what structure can you look at to find rotation?
Clavicles
What does a measurement of the ADI an indicator of?
Indicates rupture of transverse ligament
Where is the ADI measured?
Midpoint of posterior margin of anterior tubercle of C1 to nearest point on anterior margin of odontoid process
In what direction do the Cx TP’s point?
Inferiorly
What is a lateral cervical view an indicator of?
Canal stenosis (45)
Where is George’s line?
Posterior body margin line (44)
(George is gay, and likes it in the “posterior body”
What are the structures best visualized on an APOM?
C0-C1 articulation. C1-C2 joint space. Lateral masses of arches of C1 (TP's of C1). Odontoid process. paraodontoid notches. Body of C2. Skull, mandible, and dental structures.
On an APOM, what soft tissue structures need to be accounted for?
Tongue shadow and superimposition of teeth/dental appliances.
What would a Cervical Oblique indicate?
Radicular symptoms, suspected dislocation, and further assessment of posterior elements (pedicles, lamina, pillars).
T/F: The entire cervical spine is visible on Cx Obliques.
True.
Which IVF is viewed on RPO/LAO?
Left IVF
ASSPO
Which IVF is viewed on LPO/RAO?
Right IVF.
ASSPO
Describe Chamberlain’s line:
Goes from posterior hard palate to posterior foramen magnum.
Dens should not project above this line (3 mm above may be normal).
Describe the Atlantodental Interval:
Goes from midpoint of posterior margin of anterior tubercle of C1 to nearest point on anterior margin of odontoid process.
Normal is < 3 mm in an adult (< 5 mm in a child).
Indicates rupture of transverse ligament (C1-C2 instability).
Describe George’s line:
Posterior body margin line.
Goes along posterior aspect of the vertebral bodies, extrapolate across disc space.
Offset indicates antero or retrolisthesis.
Translation > 4 mm b/w two views may indicate instability.
Describe the Spinolaminar Junction Line:
Posterior cervical line.
Offset indicates antero or retrolisthesis.
Describe the Sagittal Dimension of the Cervical Spinal Canal:
Posterior surface of midvertebral body to spinolaminar junction. Minimums (varies by level): C1 - 16 mm C2 - 14 mm C3 - 13 mm C4-C7 - 12mm Indicator of canal stenosis
Describe Atlantoaxial Alignment:
“X” drawn with lines from one C0-C1 joint through opposite C1-C2 gives general idea of symmetry, rotation at C1-C2.
Lateral mass of atlas should not overhang lateral margin of C2 superior faces (>1mm).
Describe Coronal Dimensions of the Cervical Spine Interpediculate Distance:
Measure shortest distance b/w inner cortical margins of pedicles at given segment; vary by spinal level; evaluates for stenosis.
Describe Cervical Gravity Line:
Vertical line drawn through the apex of the odontoid process should pass through the seventh cervical vertebral body.
Describe the Angle of Cervical Curve:
2 lines are drawn, one through and parallel to the inferior endplate of the seventh cervical body, the other through the midpoints of the anterior and posterior tubercles of the atlas.
Construct perpendiculars and measure the angle.
Normally 35-45 degrees.
Describe Prevertebral Soft Tissue:
Space measured b/w the vertebral bodies o=ad the air shadow of the pharynx, larynx, and trachea.
Normally 10 mm at C1.
6 at C2
20 at C6
Increases with any ST mass (BPTA- blood, puss, tumor, adema)
