While interpreting the AP view of C-Spine, address these two questions:
1. Are all the spinous processes in a straight line? (Red and Blue vertical lines)
If not, consider a rotational injury.
2. Look for approximately equal height of each vertebra and also spaces between adjacent spinous processes? (Light green arrows and small blue X marks)
Most C-spine injuries are managed with immobilisation or surgical repair. Indications for surgical intervention are:
- Neurological Deficits
- Severe Pain
- Unstable Spine
Jefferson's fracture (burst # of atlas due to axial loading)
X-Ray display outward displacement of lateral masses on open-mouth view. It is treated with hallo immobilisation/ surgical repair.
Hangman's fracture: Fracture of both pedicles of C2 that occurs due to hyperextension of neck. It is treated with halo immobilisation/ surgery.
Odontoid (Peg) Fractures
Type 1 - Philadelphia collar
Type 2 - Halo vest/ Surgical Repair
Type 3 - Halo vest
Vertical Compression fracture (Treated with traction/immobilisation)
Unilateral facet dislocation: On a lateral view, the involved vertebral body will be displaced <50% of its width. On anterior view, there is rotation of the involved vertebra, with the affected spinous process pointing toward the side that is dislocated.
Bilateral facet dislocation: The vertebral body is dislocated anteriorly at least 50% of its width. These injuries usually present with neurologic deficits.
Clay Shoveler's fracture i.e. Avulsion off the end of one of the lower cervical spinous processes, classically describes with C7. Rx with a soft collar.
Images taken from: