Cross-Table Lateral C-Spine

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

1. See Also
   1. C-Spine XRay
   2. Open Mouth Odontoid
2. Indications
   1. Cervical Spine XRay in Acute Traumatic Injury
3. Evaluation: General (Mnemonic: ABCDS)
   1. Adequate film and Alignment
   2. Bony landmarks
   3. Cartilaginous space and curvature
   4. Discs
   5. Soft tissue spaces
4. 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
5. Evaluation: Alignment
   1. Assessment criteria
      1. Landmarks should line up with <3mm discrepancy
   2. Landmarks
      1. Anterior Vertebrae
      2. Posterior Vertebrae
      3. Facets
      4. Spinous process (Spinolaminar 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
6. Evaluation: Bony landmarks
   1. Trace unbroken outline of each Vertebrae
   2. Trace odontoid outline from C2 Vertebrae
7. Evaluation: Cartilaginous space
   1. Predental space (atlanto-dens interval)
      1. Distance from dens to C1 body
   2. Normal values
      1. Adult: 3mm
      2. Child: 5mm
8. 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
9. 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)