Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 85. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 838 Section Fractures Radiographs remain the imaging modality of first choice The lateral view should extend from the occiput toT1 Standard Radiographs Radiography has been the standard initial screening examination used to evaluate alert and stable patients with suspected cervical spine trauma. At least three views are recommended for alert and stable trauma patients 105 anteroposterior view cross-table lateral view open-mouth dens view The series of conventional radiographs has shown to be accurate in detecting cervical spine injuries in 84 of cases 187 . The lateral view should extend from the occiput to T1. The lower cervical spine is often obscured by the shadow of the shoulders elevated by muscle spasm or in patients with a short neck. It may be necessary to gently pull down the arms to visualize the entire T1 vertebra. In trauma patients for whom the standard three view series fails to demonstrate the cervicothoracic junction swimmer s views one arm abducted 180 the other arm extended posteriorly and supine oblique views were compared. The authors concluded that both views show the alignment of the vertebral bodies with equal frequency. However supine oblique films are safer expose patients to less radiation and are more often successful in demonstrating the posterior elements . riding facet 110 . Oakley introduced a simple system radiological ABC for analyzing plain films 164 Do not miss injuries at the cervicocranial and cervicothoracic junctions Al appropriateness correct indication and right patient A2 adequacy extent occiput to T1 penetration rotation projection A3 alignment anterior aspect of vertebral bodies posterior aspect of verte- bral bodies posterior pillar line spinolaminar line craniocervical and other lines and relationships B bones C connective tissues pre-vertebral soft tissue pre-dental space interverte- bral disc spaces interspinous gaps Davis et al. 61 described 32117 acute trauma patients. Cervical spine injuries were missed in 34 .
