InterpretationĪ structured approach to cervical spine X-ray interpretation is discussed below. If you are struggling to see down to the level of C7/T1, a fourth “ swimmer’s view” can be requested. Typically there are three standard views provided when a cervical spine X-ray is performed, these include a lateral, antero-posterior (AP) and odontoid/open-mouth view. might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of radiology interpretation stations ✨ Acquire all necessary views Spinal injury: assessment and initial management. National Institute for Health and Care Excellence.The Canadian C-spine rule for radiography in alert and stable trauma patients. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, Worthington J.Spinal immobilisation for unconscious patients with multiple injuries BMJ 2004 329:495-9.Contraindications to ionising radiation, for example in pregnancy.Ankylosed spines with negative or indeterminate CT appearances for fracture.Ambiguous CT scans, as per option 3 of standard 7.Magnetic Resonance Imaging is necessary when the following are present:.Spinal protection should be continued until an MRI is performed or the patient is fully conscious and has a normal clinical examination documented. Whilst there are no obvious features of spinal instability, the CT scan is either not of good quality and/or there are comorbidities confounding its interpretation. Clinical clearance is not confirmed until a tertiary survey is completed and documented. No features of instability, such as fracture, haematoma or joint disruption are seen.Īn unconscious or obtunded patient may be labelled “C-Spine radiologically cleared”. This scan is of good quality and there are no comorbidities confounding its interpretation. This investigation demonstrates an injury that may affect spinal stability.Ĭontinue spinal protection and seek advice from an appropriate clinical team. An initial report of cervical spine clearance imaging should be available before the patient leaves the Emergency Department and a definitive report within 18 hours of injury, indicating one of the following scenarios and actions:.If brain CT is necessary for head injury, this should include the cervical spine.If whole-body CT (WBCT) for trauma is necessary, this should include the cervical spine if injury is suspected.If a cervical spine injury is suspected, thin slice CT scanning from occiput to T4, including sagittal and coronal reconstructions should be performed without delay.Thoracic and lumbar spine scans should be obtained according to major trauma protocols.Completion of spinal imaging protocols (standard 7) in unconscious or uncooperative patients and in patients with significant distracting injuries.Normal clinical examination in an awake and orientated patient 2,3 or.Significant spinal injury is excluded following:.
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