Notes on Cervical VertebraeTrauma
Adaptation Of Positions To The Severely Injured patient
- with the patient who has sustained a severe of the cervical spine arrives by stretcher or bed, he or she should not be transferred to the radiographic table and must not e rotated. Unless removed by the physician , any cervical collar should always be left in place for the initial radiographs.
- If there is not a specially equipped emergency room, the initial examination is performed with a mobile unit or in an examining room that is large enough to accommodate the placement of a stretcher or bed where the x-ray tube can be brought into position for the required projections.
- Grid-front cassettes or a stationary grid are recommended for the AP and oblique poasitions.
* Lateral Position
- taken by the horizontal ray, presents no problem because it requires little or no adjustment of the patient’s head and neck.
- the cassette is placed in vertical position, with its lower portion in contact with the lateral aspect of the shoulder centered to the 4th cervical vertebrae and then immobilized.
CR: directed horizontally to the 4th cervical vertebrae
For the demonstration of the 7th cervical vertebrae, the shoulders must be fully depressed. Depending on the patients condition, this can be done by looping a long strip of bandage around the patient’s feet, and with his or her knees slightly flexed, attach the other end of each wrist and then extend the knees to pull the shoulders down. If the patient’s condition will not permit this maneuver, an assistant can be depress the shoulders by applying the symmetrical traction on the arms.
* AP Axial Position
-For AP Axial position the patient’s head must be held to prevent it from turning and lifted enough for the cassette to be slipped into position without appreciable movement of the patient’s head.
- Two AP images may be obtained:
(1) a 15 to 20 degree cephalic angulation of the CR for the demonstration of the vertebral bodies and their interspaces.
(2) a 20 to 30 degree caudal angulation of the CR for the demonstration of posterior vertebral elements, the articular pillars, facets, the laminae,and the spinous processes.
- The latter study should be made on a 10 x 12 in ( 24 x 30 cm )film to include the upper 3 or 4 thoracic vertebrae.
* AP Oblique Axial Position
- For the demonstration of the pedicles an the intervertebral foramina the cassette must be positioned near the opposite side being examined.
- a 45 degree lateromedial angulation of the CR.
- Have the patient’s head lifted slightly and with the cassette held so that the midpoint is at the level of the 3rd cervical body. And gently slide so that the under the head just far enough to center it under the adjacent mastoid process.
- This centering place the midline of the film approximately 3 inches lateral to the MSP.
- From the opposite side being projected, the CR is directed to the 4th cervical vertebrae and at eccentric angulation of 45 degrees medial and 15 to 20 degrees cephalad.
- If there is not a specially equipped emergency room, the initial examination is performed with a mobile unit or in an examining room that is large enough to accommodate the placement of a stretcher or bed where the x-ray tube can be brought into position for the required projections.
- Grid-front cassettes or a stationary grid are recommended for the AP and oblique poasitions.
* Lateral Position
- taken by the horizontal ray, presents no problem because it requires little or no adjustment of the patient’s head and neck.
- the cassette is placed in vertical position, with its lower portion in contact with the lateral aspect of the shoulder centered to the 4th cervical vertebrae and then immobilized.
CR: directed horizontally to the 4th cervical vertebrae
For the demonstration of the 7th cervical vertebrae, the shoulders must be fully depressed. Depending on the patients condition, this can be done by looping a long strip of bandage around the patient’s feet, and with his or her knees slightly flexed, attach the other end of each wrist and then extend the knees to pull the shoulders down. If the patient’s condition will not permit this maneuver, an assistant can be depress the shoulders by applying the symmetrical traction on the arms.
* AP Axial Position
-For AP Axial position the patient’s head must be held to prevent it from turning and lifted enough for the cassette to be slipped into position without appreciable movement of the patient’s head.
- Two AP images may be obtained:
(1) a 15 to 20 degree cephalic angulation of the CR for the demonstration of the vertebral bodies and their interspaces.
(2) a 20 to 30 degree caudal angulation of the CR for the demonstration of posterior vertebral elements, the articular pillars, facets, the laminae,and the spinous processes.
- The latter study should be made on a 10 x 12 in ( 24 x 30 cm )film to include the upper 3 or 4 thoracic vertebrae.
* AP Oblique Axial Position
- For the demonstration of the pedicles an the intervertebral foramina the cassette must be positioned near the opposite side being examined.
- a 45 degree lateromedial angulation of the CR.
- Have the patient’s head lifted slightly and with the cassette held so that the midpoint is at the level of the 3rd cervical body. And gently slide so that the under the head just far enough to center it under the adjacent mastoid process.
- This centering place the midline of the film approximately 3 inches lateral to the MSP.
- From the opposite side being projected, the CR is directed to the 4th cervical vertebrae and at eccentric angulation of 45 degrees medial and 15 to 20 degrees cephalad.
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