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Cervical spine x ray views4/8/2024 Remarkably, the latest version of the American College of Radiology (ACR) Appropriate Guidelines for Imaging of Suspected Spine Trauma (2009) advocates thin-section CT as the primary screening study for suspected cervical spine injury in adults, removing plain radiography (x-ray) from this position. We review the evidence for use of CT and x-ray, comparing their sensitivity for detection of fractures. Imaging of the spine has undergone a revolution with the advent of multidetector CT with multiplanar reconstructions. Similar decision instruments can identify patients who require thoracic and lumbar imaging. We review two well-validated clinical decision rules (CDRs) that can identify patients at low risk of cervical spine injury who do not require any imaging. In many ways, the more difficult task for the emergency physician is not the interpretation of the image but the decision to image the spine. Thoracic spine metastatic disease with cord compressionĭegenerative joint disease and disc herniation Thoracolumbar compression and burst fractures T2 corner avulsion fractures (extension teardrop) Three-dimensional CT reconstructions of the normal cervical spineĬervical facet fractures with spinal cord injury on MRIĪcute cervical ligamentous injuries with x-ray, CT, and MRI findings The list in Table 3-1 can guide you to the relevant figure, where diagnostic features are discussed in detail. The figures in the chapter span a range of important spinal pathology, moving from cephalad to caudad. The figure captions are designed to allow the figures to stand alone, so we spend relatively little time discussing specific fracture patterns in the text. Don’t be daunted by the number of figures in this chapter-we explore injuries and nontraumatic spinal pathology in many imaging planes and in multiple modalities to maximize your three-dimensional understanding. We correlate CT findings with x-ray when possible, and we demonstrate associated soft-tissue abnormalities identified on magnetic resonance imaging (MRI). Our discussion of all spinal regions starts with interpretation of images, with a focus on computed tomography (CT) scan. Although differences exist, many common themes are shared in both the selection and the interpretation of diagnostic studies for all regions of the spine. In this chapter, we discuss imaging of the cervical, thoracic, and lumbar spine.
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