The associated fracture of the posterior arch of C1 is seen by both examinations ( Figure 6-1 A, C). The comparative difficulty of detection by radiography is shown by a fracture of the dens that is hard to see, if not impossible to identify, on the lateral cervical spine radiograph ( Figure 6-1 A ) but is clearly shown by the MDCT sagittal reconstruction ( Figure 6-1 B ). With these advances it became apparent that MDCT is more accurate and more efficient in the detection and depiction of spinal injuries. This permitted coronal and sagittal reconstructions of the entire length of the cervical spine in addition to the standard axial images. Computed tomography (CT) was first introduced in the 1970s but did not prove adequate for the evaluation of the acutely injured spine until the early 2000s with the introduction and perfection of multidetector CT (MDCT), with rapid exposures coupled with the development of immediate and readily accomplished multiplanar image reconstructions. Though traditional and long the mainstay of cervical spine evaluation, radiographs of the cervical spine now have a limited role in the initial assessment of cervical spine trauma. Teardrop fractures at anterior margins of vertebral bodiesĬlosely evaluate prevertebral soft tissues for swelling. Spondylosis and degenerative changes in elderlyĬheck for evidence of hyperextension injury. Obtain an MRI for those with neurologic signs and symptoms.Ĭheck width of spinal canal for spinal stenosis. Where to look when you see nothing at all Two- or three-level fractures encountered in 20% of spinal fracturesĬT entire T and L spine after identifying fracture of C-spineįind a compression fracture: look for associated posterior element injury.įind a vertebral body injury: look for bony compromise of spinal canal.įind a facet malalignment on one side: look for contralateral facet malalignment/fracture.

Where else to look when you see something obviousįind an injury at one level: closely evaluate the entire cervical spine above and below.įractures of C1 and C2 often associated with fractures of the lower cervical spine (C4-C7) Subtle fractures on radiography – need CT Relatively more involve lower cervical spine, C4-C7 Spinal cord injury without radiographic abnormality (SCIWORA)Īt and beyond 14 years of age injuries similar to those of adults Rare – apophyseal separations of synchondrosis between dens and body of C2 Relatively more involve upper cervical spine Often with either subtle or even without overt radiographic abnormality (SCIWORA)įracture of inferior or superior anterior margins of vertebral bodyįracture of osteophyte at superior or inferior anterior margin of vertebral bodyįractures in DISH (diffuse idiopathic skeletal hyperostosis)Ĭommon sites of injury in children and adolescentsĬervical spine injury ( CSI) rare in children under 8 years of age

Spinal cord injury in presence of significant degenerative arthritis and disc disease Intervertebral disc, joint capsules, and interspinous ligamentĪnterior and posterior longitudinal ligamentsįacets – unilateral or bilateral – rotation, shearing injuries Vertical sagittal split of vertebral body Jefferson fracture – fractures of ring anterior and posteriorĬ2 pars interarticularis fractures – hangman’s fractureĬompression, distraction, and translation/rotation injuries (SLIC) Axial, sagittal, and coronal noncontrast images in bone algorithmĮxtending through at least the level of T1Īxial and sagittal images in soft tissue algorithmĬraniocervical junction (Skull base – C2)

Cervical spine complete x ray