Orthopedics Book

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Cross-Table Lateral C-Spine

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  1. See Also
    1. C-Spine XRay
    2. Open Mouth Odontoid
  2. Interpretation Technique (Mnemonic: ABCDS)
    1. Adequate film and Alignment
    2. Bony landmarks
    3. Cartilaginous space
    4. Discs
    5. Soft tissue spaces
  3. Adequate film criteria
    1. Visualize all seven vertebrae (including C7-T1)
    2. Maneuvers to enhance view of lower C-Spine C7-T1
      1. Pull down on arms during cross-table lateral
      2. Swimmer's View
      3. Cervical Spine CT
  4. Alignment
    1. Assessment criteria
      1. Landmarks should line up with <3mm discrepancy
    2. Landmarks
      1. Anterior vertebrae
      2. Posterior vertebrae
      3. Facets
      4. Spinous process (Spinolaminar line)
        1. Middle of anterior spinous process lines up C1-C3
    3. Normal variants: Pseudosubluxation of C2 and C3
      1. Normal in children
      2. Seen in 20% of children under age 8 years
    4. Abnormal findings
      1. Subluxation of >=3 mm is abnormal
      2. Angulation >11 degrees is unstable
  5. Bony landmarks
    1. Trace unbroken outline of each vertebrae
    2. Trace odontoid outline from C2 vertebrae
  6. Cartilaginous space
    1. Predental space
      1. Distance from dens to C1 body
    2. Normal values
      1. Adult: 3mm
      2. Child: 5mm
  7. Discs
    1. Assess symmetry of disc spaces
  8. Soft Tissue spaces
    1. Soft Tissue stripe
      1. Normal C2 stripe: 5 mm
      2. Normal C5 stripe: 2 mm
    2. Normal Fat tissue stripe <3 mm

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