Skip to Main Content

++

A 41-year-old man was brought to the ED following a motor vehicle collision in which he was an unrestrained driver whose vehicle hit a roadway median divider. The automobile driver’s air bag deployed. At the scene, the patient was confused and “oriented times two.” Upon his arrival in the ED, his mental status was normal and he admitted to having had “a few beers.” He complained of lower back and neck pain.

++

The patient was hemodynamically stable. The only evident trauma was a left parietal scalp laceration and hematoma. His neurological examination was normal.

++

The chest and pelvis radiographs were negative for an acute injury. The cervical spine radiographs are shown in Figure 1.

++
+

  • Are there any abnormalities?

++

Note: Loss of anterior vertebral body height at C4 is not an acute fracture. However, there is a second finding that represents an unstable cervical spine injury.

++

(Arrow = windshield glass lying next to the patient’s scalp.)

++
++

Lateral View—ABCS Approach

++

All seven vertebrae are visible (Figure 2). The patient’s position is slightly rotated, as evident by the lack of perfect overlap of the left and right articular facets at each vertebra.

++
++

The overall alignment of the vertebral bodies and spinolaminar line appears normal. The intervertebral disk spaces and the spaces between the spinous processes are uniform.

++

The prevertebral soft tissues are less than 5 mm at C1, C2, and C3. However, close examination of the contour of the prevertebral soft tissue reveals a slight focal convexity (bulge) anterior to the base of the dens (white arrowhead).

++

Examination of the bones of the lower cervical spine reveals narrowing of the anterior aspect of the C4 vertebral body (arrow,Figure 2). However, based on the radiographic findings and subsequent evaluation with CT and flexion/extension views, this represents an old injury rather than an acute fracture.

++

When examining the bones of the cervicocranium, several radiographic landmarks should be noted. These include the predental space, the posterior arch of C1, the dens, the C2 vertebral body, and the posterior arch of C2 (Figure 3).

++
Figure 3
Graphic Jump Location

Radiographic landmarks of the cervicocranium.

++

A distinctive radiographic landmark overlies the body of C2—the “ring of C2” (...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.