Cross-Table Lateral C-Spine

Aka: Cross-Table Lateral C-Spine, Lateral Cervical Spine XRay, Lateral C-Spine XRay, Cervical Spine XRay Lateral View Interpretation

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II. Indications

  1. Cervical Spine XRay in Acute Traumatic Injury

III. Evaluation: General (Mnemonic: ABCDS)

  1. Adequate film and Alignment
  2. Bony landmarks
  3. Cartilaginous space and curvature
  4. Discs
  5. Soft tissue spaces

IV. Evaluation: Adequate film criteria

  1. Visualize all seven Vertebrae (including C7-T1)
    1. Major pitfall: Inadequate visualization of the entire Cervical Spine from C1 to the top of T1
    2. C7-T1 is a common site of Cervical Spine Injury (visualization is critical)
  2. Maneuvers to enhance view of lower C-Spine C7-T1
    1. Pull down on arms during cross-table lateral
    2. Swimmer's View
    3. Cervical Spine CT

V. Evaluation: Alignment

  1. Assessment criteria
    1. Landmarks should line up with <3mm discrepancy
  2. Landmarks
    1. Anterior Vertebral body line
    2. Posterior Vertebral body line
    3. Spinolaminar line (posterior margin of the spinal canal)
    4. Spinous process line
      1. Middle of anterior spinous process lines up C1-C3
  3. Normal variants: Pseudosubluxation of C2 and C3
    1. Normal in children
    2. Seen in 20% of children under age 8 years
  4. Abnormal findings
    1. Subluxation of >=3 mm is abnormal
    2. Angulation >11 degrees is unstable

VI. Evaluation: Bony landmarks

  1. Trace unbroken outline of each Vertebrae
  2. Trace odontoid outline from C2 Vertebrae for defects

VII. Evaluation: Cartilaginous Space

  1. Predental space (atlanto-dens interval, anterior atlanto-odontoid space)
    1. Atlas anterior margin (C1) to Odontoid process or dens (C2)
  2. Normal values
    1. Adult: <=3mm
    2. Child: <=4-5mm

VIII. Evaluation: Discs

  1. Assess symmetry of disc spaces
  2. Observe for avulsion Fractures off the Vertebral bodies
    1. Superior avulsion Fractures are stable
    2. Inferior avulsion Fractures are unstable

IX. Evaluation: Soft Tissue spaces

  1. Normal Fat tissue stripe <3 mm
  2. Maximum normal width of soft tissue stripe (Mnemonic: 6 at 2 and 22 at 6)
    1. Normal C2 stripe: 6-7 mm
    2. Normal C5-6 stripe: 22 mm (approximately Vertebral width)

X. References

  1. Ouellette and Tetreault (2015) Clinical Radiology, Medmaster, Miami, p. 42-50

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