Next, check if the x-ray is a real lateral view, or if it is slightly rotated. At this point it is not easy to differentiate ‘ABCs’, because of all the acronyms across the field of medicine, but the ‘ABCs’ in this case stands for: A – alignment and adequacy, B – bone abnormalities, C – cartilage space assessment and S for soft tissues.Ī – Alignment and adequacy: First, visualize the spine from the base of the skull to the C7-Th1 junction. Inspection of the x-ray should be thorough, methodical and complete. The lateral (cross-table) view is the most helpful x-ray study in diagnosing c-spine injuries. Shoulders can be depressed by pulling the arms down slowly and steadily, or if the patient is capable, asking them to depress one shoulder and lift the other hand above his head to achieve the swimmer’s position, which better visualizes the lower vertebrae.įigure 2: Two examples of a cervical x-ray that is not good enough for the evaluation of the possible injury of the neck. Such lesions that leave the trapezius muscle unopposed occur in the lower cervical region. The C7-Th1 vertebrae may be obscured in muscular or obese patients (Figure2), or in patients with spinal cord lesions that affect the muscles which normally depress shoulders.Only c-spine radiograph one should be satisfied with is the one showing all of the 7 cervical vertebrae (C1-Th1).Most spinal injuries occur at the junctions of the spine: craniocervical, cervicothoracic, thoracolumbar and lumbosacral.
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