CERVICAL SPINE

erick

ANATOMY
There are two
anatomically distinct
regions of the cervical
spine:
cervicocranium (C1
and C2)
lower cervical spine
(C3 to C7).

 The atlas (C1) is an osseus ring with two

lateral masses that articulate superiorly with
the occipital condyles and inferiorly with the
axis (C2)
C1 has no vertebral body. The odontoid
process (the dens) projects superiorly from
the C2 vertebral body and articulates with the
anterior portion of C1. This articulation is
maintained by the transverse atlantal
ligament.

Each of the lower cervical vertebrae

(C3 to C7) consists of a vertebral body,
two lateral masses with superior and
inferior articular facets, pedicles (connect
the lateral masses to the vertebral body),
paired laminae, and a spinous process

 The spinal cord is located within the

vertebral canal that is made up by the
posterior aspect of the vertebral body,
the pedicles, and the laminae.
The transverse processes project
laterally from the pedicles. The
transverse processes form U-shaped
channels for the spinal nerve roots and
have a perforation for the vertebral
artery.
The vertebral bodies are joined
together by the fibrocartilaginous
intervertebral discs. The lateral
masses articulate via the facet joints
and form lateral supportive columns of
the cervical spine.
Vertebral alignment is maintained by 4
strong ligaments: the anterior
longitudinal ligament, the posterior
longitudinal ligament, the ligamentum
flavum, and the interspinous ligament

WHEN TO ORDER CERVICAL

SPINE RADIOGRAPHS
NEXUS LOW-RISK CRITERIA
CANADIAN CERVICAL SPINE RULE

 The NEXUS rule is simpler but the

criteria depend more on the
subjective assessment of the clinician
The Canadian rule is more complex
but provides more factors to consider
in deciding to obtain or omit
radiography, such as the mechanism
of injury, various low-risk features,
and the testing of neck mobility.

The standard cervical spine

radiographic series includes three
views:
(1) lateral view,
(2) open mouth view (an AP view of
the
cervicocranium)
(3) AP view of the lowercervical spine

HOW TO READ CERVICAL SPINE

RADIOGRAPHS
Systematic approach
provides a stepwise review of
importantradiographic landmarks. Such a
systematic approach is needed because of
the anatomical complexity of the cervical
spine and relatively low frequency of injuries.
Targeted approach
involves identification of specific injury
patterns and enables accurate and efficient
radiograph interpretation.

Systematic Approach
Overall Review This uses an ABCS mnemonic
device
assessing the adequacy of the radiograph,
vertebral alignment,
the bones (for fractures or deformity),
cartilage (spaces between adjacent vertebral
bodies and between the spinous processes)
prevertebral soft tissues
A properly performed lateral radiograph
demonstrates all seven cervical vertebrae and the
C7-T1 interface

CLASSIFICATION OF CERVICAL SPINE INJURIES

(Targeted approach)

Hangmans fractures are classified into three types depending on

the degree of displacement
Type I is nondisplaced or minimally displaced (less than 3 mm).
This is the most frequent type (65% of cases) and is the most
subtle radiographically. Neurological deficits usually do not occur,
which contributes to the risk of missing the injury.
Type II fractures (28% of cases), the body of C2 is displaced or
angulated with respect to C3.
Type III fractures (7% of cases), the C2C3 articular facet joints
are also disrupted.
When one or both of the fractures involves the posterior portion

TERIMA KASIH