Assessment requires a systematic approach. The lateral view is often the most informative image. If the lateral view does not show the vertebrae down to T1 then a repeat view with the arms lowered or a ' Swimmer's view' may be required. In the context of trauma these images are all difficult to acquire because the patient may be in pain, confused, unconscious, or unable to cooperate due to the immobilisation devices. The 3 standard views are - Lateral view - Anterior-Posterior (AP) view - and the Odontoid Peg view (or Open Mouth view). Imaging should not delay resuscitation.įurther imaging with CT or MRI (not discussed) is often appropriate in the context of a high risk injury, neurological deficit, limited clinical examination, or where there are unclear X-ray findings. This is because normal C-spine X-rays cannot exclude significant injury, and because a missed C-spine fracture can lead to death, or life long neurological deficit.Ĭlinico-radiological assessment of spinal injuries should be managed by experienced clinicians in accordance with local and national clinical guidelines. S Soft tissues: The prevertebral soft tissues can be used as an indicator of an acute swelling or hemorrhage resulting from an injury, and may sometimes be. Bones - Cortical outline/Vertebral body heightĬlinical considerations are particularly important in the context of Cervical spine (C-spine) injury.Alignment - Anterior/Posterior/Spinolaminar.Look at all views available in a systematic manner.Clinical considerations are of particular importance when assessing appearances of C-spine X-rays.Normal C-spine X-rays do not exclude significant injury.
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