Spine Fractures

Reading C-spine Films

A – Alignment and adequacy:

  • Anterior, posterior and laminar lines should all be well aligned and smooth
  • Should be able to see superior border of T1

B – Bones:

  • Evaluate each vertebrae C1-7
  • The lateral mass of C1 should not overhang C2

C – Cartilage and spacing

D – Dens:

  • Normal predental space on CT < 3mm
  • Odontoid view on plane films

S – Soft tissues:

  • The prevertebral space should be 6 mm at C2 & 22 mm at C6
  • More space is concerning for hematoma or edema

Unstable C-Spine Fractures

Jefferson – Jefferson fx – C2 burst with axial loading

Bit – Bilateral jumped facets – forced hyperflexion

Off – Odontoid fracture – Types II and III are unstable

A – Atlanto-occipital dislocation

Hangman’s – Hangman’s fracture – C2 vertebra fx off pedicles w/ extension

Toe – Teardrop

Other Important Fractures

Clay Shoveler’s Fx – Avulsion fracture of spinous process d/t flexion – stable

Chance Fx – Lumbar flexion fracture causing distraction fracture through posterior vertebral body. Unstable and high risk for viscous intraabdominal injury (often caused by lap belt only wearing in MVC).