4/9/2024 0 Comments Cervical spine x ray normalMRI is indicated in any patient where a potential spinal cord injury is suspected clinically or there are progressive neurological defects such as due to a contusion of the cord ( Fig. CT is also indicated as the primary imaging for patients with high risk of spinal injury, unexplained soft tissue swelling or if a fracture is seen on the radiographs. However, it may remain difficult to obtain satisfactory films, particularly in severely ill patients, and then a CT is indicated so the entire spine segment can be imaged. Adequate imaging of the C7/T1 junction on the lateral film may be facilitated by gentle traction on the arms to depress the shoulders or by obtaining a view through the axilla (swimmer’s view). It is important that the entire cervical spine from the craniocervical to the cervicothoracic junction has been imaged otherwise a low unstable injury may be missed. The vertebral body is flattened and sometimes referred to as a ‘vertebra plana’ ( Fig. Complete collapse of one or more vertebral bodies may occur in children or young adults with a solitary site of Langerhans’ cell histiocytosis (eosinophil granuloma). Associated fractures may be seen in the pedicles or neural arch, but otherwise the bone and discs are normal. The discs are normal but may be impacted into the fractured bone. A compression fracture is commonly due to hyperflexion of the spine, causing the vertebral body to become wedge-shaped ( Fig. The disc spaces are normal or even slightly increased in height and the pedicles are intact ( Fig. There is generalized reduction in bone density leading to compression fractures. There may be bone destruction next to the affected disc but the pedicles are usually intact ( Fig. The adjacent disc space is nearly always narrow or obliterated. The disc spaces are usually normal ( Fig. ![]() The pedicles are a good place to look for evidence of bone destruction on plain film examination. Bone destruction, or replacement of normal marrow by a lytic tumour, may be visible. If any collapse is present, it is essential to look at the adjacent disc to see if it is narrowed, to check if part of any pedicle or cortical margin is destroyed and to assess the posterior vertebral wall to ensure that there is no compromise of the central spinal canal containing the cord or cauda equina.Ĭauses of vertebral collapse ( Box 13.1) include: This could be a normal bone subjected to abnormal stress such as in trauma or an abnormal weakened bone subjected to normal stress such as in metastases or myeloma. A reduction in intervertebral space associated with poor visualization of the endplates may be seen in disc space infection.Ī collapsed vertebral body is one that has lost height. A reduction in intervertebral height usually implies degenerative disc disease and may be associated with endplate sclerosis and osteophytes around the endplate margins ( Fig. In the lumbar spine, the disc spaces increase slightly in height going down the spine. ![]() Normally, the disc spaces are the same height at all levels in the cervical and thoracic spine. There are some abnormalities detected on plain radiographs that often permit a diagnosis to be made, although other imaging will often be required for confirmation. In the lumbar spine, the nerve roots run in the lateral recess of the lumbar canal across a disc level before exiting under the corresponding pedicle. the T4 nerve exits the spine through the T4/T5 exit foramen). Due to the presence of C8 nerves, beyond C7/T1 the nerves are named according to the pedicle they pass under (i.e. the C5 nerve exits the spine through the C4/C5 intervertebral foramen). At each level in the cervical region (C3–C7), the anterior and posterior roots extend laterally from the cord and pass into the anterolateral-orientated exit foramina and are named according to the pedicle they pass over (i.e.
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