Cervical Trauma Routine

Question 1

Lateral neutral position

Answer 1

Align mid-coronal plane to CR and midline of table.
Patient lateral.
Relax shoulders down.
Lift chin up

Question 2

Lateral neutral CR

Answer 2

CR perpendicular to C4-5. Book: 1” distal to mastoid tip.

Question 3

Lateral neutral structures

Answer 3

Cervical bodies.
Intervertebral joint spaces.
Articular pillar.
Spinous processes.
Zygapophyseal joints.
C1-T1 or C1-7.
Rami of mandible not superimposed over C1

Question 4

Lateral extension position

Answer 4

Align mid-coronal plane to CR and midline of table.
Patient lateral.
Relax shoulders down.
Extend chin up and head and neck back.

Question 5

Lateral extension CR

Answer 5

CR perpendicular to level of C4

Question 6

Lateral extension structures

Answer 6

Cervical bodies.
Intervertebral joint spaces.
Articular pillar.
Spinous processes.
Zygapophyseal joints
Plus functional anatomy

Question 7

SFMC routine

Answer 7

Lateral extension 
Lateral neutral
45 degree LAO 15-20* caudally 
45 degree RAO 15-20* caudally 
AP axial 15-20* cephalic 
AP odontoid

Question 8

45 degree LAO and RAO 15-20* caudally

Positioning

Answer 8

PA oblique.
Patient PA.
Rotate body and head 45*
Chin extended and elevated to prevent mandible superimposition over vertebra.

Question 9

CR for 45* LAO and RAO 15-20* caudally

Answer 9

CR directed 15-20* caudal to level of C4

Question 10

Structures 45* LAO 15-20* caudally

Answer 10

Left Intervertebral Foramina and pedicle of C3-7

Mandible and occipital bone are not overlapping C1-2

Question 11

Structures 45* RAO 15-20* caudally

Answer 11

Right intervertebral Foramina and pedicle of C3-7

Question 12

AP axial 15-20* cephalic position

Answer 12

MSP to midline of table or vertical Bucky. Center IR at the level of C4.
Raise chin.

Question 13

AP axial 15-20* cephalic CR

Answer 13

CR angled 15-20* cephalic @ level of C-4. Inferior to upper margin of thyroid cartilage.

Question 14

AP axial 15-20* cephalic structures

Answer 14

C3-T2 vertebral bodies and intervertebral disk spaces.

Question 15

AP odontoid position

Answer 15

MSP to midline of table or vertical Bucky. Center the IR at the level of the axis
Lower margin of upper incisors and mastoid tip are perpendicular to IR.
Then open mouth, without moving head.
Pt must remove dentures, piercings, hair pins, jewelry.

Question 16

AP odontoid CR

Answer 16

CR perpendicular to open mouth

Question 17

AP odontoid structures

Answer 17

Odontoid process.
Vertebral bodies of C2. lateral masses of C1.
Zygapophyseal joints between C1 and C2.
No teeth in way.

Question 18

What are the optional obliques?

Answer 18

45* RPO and LPO 15-20* cephalic position

Question 19

Position for 45* RPO and LPO 15-20* cephalic position

Answer 19

Patient AP oblique 45*.

Chin extended to prevent mandible superimposition over vertebrae.

Question 20

CR 45* RPO and LPO 15-20* cephalic position

Answer 20

CR directed 15-20* cephalic to level of C4

Question 21

Structures 45* RPO and LPO 15-20* cephalic position

Answer 21

See the intervertebral Foramina furtherest from IR.
RPO- left intervertebral Foramina and pedicle.
LPO- right intervertebral Foramina and pedicle.

Question 22

Technical factors for cervical spine trauma

Answer 22

72” SID.
Small focal spot.
KVp 80
Breathing.

Question 23

Non trauma cervical routine, exclude?

Answer 23

AP odontoid and Lateral extension

Question 24

Functional studies of the lateral cervical vertebrae show?

Answer 24

Normal AP movement or absence of movement. The spinous processes are elevated and widely separated in hyperflexion and depressed closely in hyperextension.

Question 25

Position for hyperflexion lateral

Answer 25

True lateral. IR centered at level of C4. Drop head forward and draw chin as close as possible to chest.

Question 26

Position for lateral hyperextension

Answer 26

Pt elevate chin as much as possible.

Question 27

Structures for lateral hyperflexion

Answer 27

Intervertebral disks and the zygapophyseal joints. Body of mandible in almost vertical in normal pt. All 7 spinous processes in profile, and elevated and widely separated.

Question 28

Structures of lateral hyperextension

Answer 28

ntervertebral disks and the zygapophyseal joints. Body of mandible almost horizontal in a normal pt. All 7 spinous processes in profile, depressed and closely spaced.

Question 29

During an open mouth AP, if the incisors are projected over the dens, that means?

Answer 29

The neck is flexed too much towards chest; so lift the chin more.

Question 30

AP open mouth- if the base of skull is projected over the dens,

Answer 30

the neck is extended too much; lower the chin.