Chapter V-5

A 42-year-old man was the front seat passenger in a car that was struck on the driver’s side by another vehicle. Neither car was going at high speed. Damage to the patient’s car was limited to the front fender; the windshield was not “spidered.” The patient was wearing a seat belt at the time of the collision. He was brought to the ED in full spine immobilization and was triaged to one of the examination rooms.

The patient was awake and alert with no overt signs of trauma. His vital signs were normal. He complained of pain in his neck, lower back, and right wrist. He noted that he had struck his head on the car door and had been “dazed” for a few seconds, but was uncertain whether he had lost consciousness.

On examination, he had mild midline neck tenderness without deformity. There were good bilateral breath sounds without chest wall tenderness. His abdomen, pelvis, and extremities showed no signs of injury. The neurological examination was normal.

The patient was removed from the “long board” and sent for cervical spine radiography. The radiographs are shown in Figure 1.

• Are there any abnormalities?

Although ABCS (alignment, bone, cartilage, and soft tissues) is a convenient mnemonic device for the interpretation of the lateral cervical spine radiograph, one element seen on the lateral view is not emphasized in this scheme–alignment of the articular facets and lateral masses of C3–C7.

Each vertebra has two lateral masses and each lateral mass has a superior and inferior articular facet. On the lateral view, each lateral mass has a diamond shape formed by the superior and inferior articular facets and the anterior and posterior cortical surfaces. In a perfectly positioned lateral view, the left and right lateral masses are exactly superimposed. More often, the patient’s positioning is slightly rotated and the lateral masses are not exactly superimposed (Figure 2).

###### Figure 2

Effect of rotation of a lower cervical vertebra as seen on the lateral radiograph.

(A) Correct alignment (no rotation): the left and right lateral masses are perfectly superimposed on the lateral view.

(B) Rotational malalignment: the left and right lateral masses are not superimposed.

[From Gerlock AJ, Kirchner, SG, Heller RM, Kaye JJ: The Cervical Spine in Trauma, Advanced Exercises in Diagnostic Radiology, Vol. 7, Saunders, 1978, with permission.]

In this patient’s lateral view (Figure 1), the positioning is slightly rotated and the ...

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

## 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.