Trauma: Spinal XR

T/L spine
Paediatric notes


Lateral: base of skull, 7 vertebrae, and sup. T1
- imay need a swimmer's view for C7/T1 jx.
Odontoid: entire odontoid and C1,C2 articulations.

4 lordotic curves:
- anterior vertebral bodies
- anterior spinal canal
- posterior spinal canal
- spinous process tips
* look for loss of alignment and narrowing of canal

Vertebrae contour and axial height.
Lateral bony mass: pedicles, facets, laminae, transverse processes
Spinous processes
* look for deformity, #

Intervertebral discs
Posterolateral facets

Soft-tissue spaces
Prevertebral space (>5mm opposite C3)
Prevertebral fat stripe
Space between spinous processes (torn ligaments).
* look for enlarged prevertebal space or increased distances between spinous processes.

AP film
Most useful in identifying unilateral facet dislocations where nil seen on lateral film.

T/L spine

Symmetry of pedicles
Contour of bodies
Height of disc spaces
Central position of spinour processes

Contour of bodies
Presence of disc spaces
Encroachment of body on canal.

* Unstable #s commonly cause widening of the interpedicular distance
* Lateral films show subluxations, compressions and Chance #s
* CT is better for posterior #s, canal compromise in burst #.

Considerations in Paeds

Pseudosubluxation complicates c-spine evaluation
- 40% of children <7 have C2 on C3 anterior displacement
- 20% up to 16 yrs
- less commonly at C3-4.
- >3mm of movement seen here when jts studied by flexion/extension maneuvers.

To determine if pseudosubluxation vs true injury:

- place child's head in neutral position and repeat XR (pseudo is more pronounced in flexion)
- compare with clinical findings.

Increased dens-C1 anterior arch distance increases in ~20% of young children.
- gaps exceeding noral adult limits are seen frequently

Skeletal growth plates can resemble fractures
- basilar odontoid synchondrosis appears as a radiolucent area at base of dens in children <5
- apical odontoid epiphyses appear as separations on the odontoid XR and are usually seen at 5-11yrs.
- growth centre of spinous process may resemble a # at the tip.

Spinal cord injury without radiogaphic abnormality is more common in kids
- 2/3 of children with spinal cord injury have a normal spine series
Spinal XRs do not exclude significant spinal cord injury
Assume instability
Maintain immobilisation
Obtain consult