C - Spine Instability, Flexion Extension Xrays - Everything You Need To Know - Dr. Nabil Ebraheim

Описание: Dr. Ebraheim’s educational animated video describes flexion / extension xrays of the cervical spine.
Flexion/extension views detect subtle ligamentous injuries that are not apparent on routine neutral static views. It is done to avoid missing an unstable injury in the cervical spine. It is one of the many tactics that improve understanding of the extent and personality of the neck injury.
Other tactics include:
•Imaging of the C7-T1 junction
•Look at the occiput C1-C2 area
•Image the entire spine if you have a cervical spine injury (non-contagious cervical spine injury can be up to 15%)
Contraindication
•Head injury, intoxicated patient
•Neurological deficit
•Patient is unable to do flexion/extension because of pain ( can do it a few days later when the spine is less tender
•It is done when the patient has no abnormal findings on x-rays and the patient has pain (lateral, AP and odontoid views)
Patient should do the flexion/extension by themselves under direct supervision
MRI is an alternative, but has its own advantages and disadvantages
The atlanto-dens interval (ADI) is the distance between the odontoid and the anterior arch pf the axis. If the atlanto-dens interval is more than 3 mm in adults, check for a transverse ligament injury. The space available for cord (SAC) is the space between the odontoid and the posterior arch of the axis.
Lower c-spine planes
A-Anterior vertebral line
B-Posterior vertebral line
C-Spinolaminar line
The normal cervical spine should represent smooth curves with no malalignment or displacement. In cervical spine injuries, displacement more than 3.5 mm signifies an unstable injury.
Normal parallel cervical endplates. In cervical spine injuries, angulation of more than 11 degrees of contiguous cervical vertebrae signifies an unstable injury.

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