Orthopedics Book


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)

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