PMC5088667_01
First diagnostic images (x-rays) of the cervical spine. Figure 1 shows a cervical spine series consisting of AP lower cervical (APLC) (A), lateral cervical (B) and AP open mouth (APOM) (C). These X-rays were the first diagnostic images of the cervical spine of the 49 year old bicyclist, taken at the chiropractor's office 18 days following her traffic crash. The x-rays reveal an acute kyphotic angle between C6-C7 and a minor spondylolisthesis of C6 (3-4 mm) with suspicion of a fracture dislocation of the C6-C7 facet joints. There is a fracture of the anterior part of the vertebral body of C7 (a). There is reduced height of the articular column on the right side at C6 with suspicion of a fracture (b). There is a splitting fracture of the spinous process of C6 (c)
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Fig1
Due to the history a cervical spine x-ray series (APLC, APOM and lateral) was performed initially at the chiropractor's office (Fig. 1).
First Computed Tomography images of the cervical spine. Figure 2 shows the first Computed Tomography scanning obtained on the same day as the conventional x-rays in Fig. 1. The two images are 3D reconstructions of the original CT images with a slice thickness of 1 mm, where A is viewed from an anterior right angle and B is viewed from a posterior right angle. There is clear evidence of a fracture of the spinous process of C6 (a). The height of the articular column on the right side at C6 is reduced due to a fracture affecting the articular column (b). There is a fracture of the transverse process of C7 on the right (c). The vertebral body height of C7 is reduced at the anterior aspect (d). Please note that the figure does not illustrate all identified injuries
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Fig2
Post surgery control x-rays of the cervical spine. These two x-ray images ((APLC) (a) and lateral cervical (b)) were obtained at the hospital approximately 3 months following stabilizing osteosynthesis of the cervical spine. The images show a kyphotic angulation in the lower cervical spine with well positioned pedicle screws including longitudinal bars at both sides joining C6 to C7. There are no signs of osteolysis or loosening at the surroundings of the screws and the fractures appears to have healed accordingly
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Fig3
Control x-rays were performed 3 months after surgery revealing persistent kyphosis but adequate healing of the fractures and surgical sites (Fig. 3).
The Canadian C-Spine Rule. Reuse with permission from the author
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Fig4
In clinical settings the CCR (Fig. 4) have been shown to be superior to the NEXUS criteria with regard to diagnostic accuracy.