The cervical spine images on this page all have the side marker on the side of the intervertebral foramen demonstrated. Some centres will prefer the side marker to also refer to the intervertebral foramina demonstrated. The images need to be flipped horizontally to be viewed in the anatomical position. The PA obliques have the marker placed PA on the IR on the side touching the IR. Given that they are taken AP, they do not need to be flipped horizontally to be viewed The AP obliques have marker placement on the side away from the IR. Oblique cervical spine views can be performed erect or supine and AP or PA.Įssentials of Skeletal RadiologyTerry Yochum and Lindsay Rowe3rd Edition, Volume 1 Osteophyte impingement of intervertebral foramen arrowed Patient with severe degenerative disease. The cervical nerve roots can be seen in this model exiting through the intervertebral foramina Oblique radiographs of the cervical spine are necessary if the condition is to be confirmed radiologically. This is a common cause of brachialgia in middle age. The presence of osteo-arthritis in the unco-vertebral articulations of the lower cervical spine frequently produces pressure on the nerve-roots lying in the intervertebral foramina. The oblique view shows the intervertebral foramina formed by the inferior notch of the pedicle of the vertebrae above and the superior notch of the pedicle of the vertebrae below. This can be caused by pressure on the nerves which exit the cervical spine through the intervertebral foramina. The oblique view of the cervical spine can be important in patients with pain and/or altered sensation in their upper limbs. This page is dedicated to answering some of these questions What exposure technique should be employed?.This allows for discrepancies in the tilt of the head (flexion/extension of the cervical spine).Oblique views in radiography tend to be problematic. To achieve the best angle, the central ray should be directed at an angle that parallels the plane of the mandible and then directed to just below the hyoid bone. An excessive or insufficient angle can distort these disc spaces. To project the intervertebral disc spaces open, the central ray should be directed perpendicular to the long axis of the vertebral column 3, 4. This angle can and will vary between 5-20° depending on the position of the head. For this reason, a cephalic angle is required to project through the long axis of the vertebral column. Correcting tube angle errors and head tilt errorsĪ lordotic curvature exists in the cervical spine. The spinous process will rotate toward the pedicle of the side farther from the image receptor 3. The spinous process should be midline of the vertebral body, equidistant from both pedicles 3. Any deviation from the midline indicates rotation is present. Rotation can be detected by looking at the spinous processes in relation to the pedicles. make sure that any removable artifacts such as earrings, glasses or metal dentures are removed to avoid obscuring the anatomy of interest.spinous processes should be midline, equidistant to the pedicles, indicating that there is no rotation.cervical spine intervertebral disk spaces should be open 2.superiorly to include C2 and inferiorly to include T2.laterally to include the entire cervical spine.the central ray is midline centered at the level of C4 to enter immediately below the hyoid bone.chin should be raised to align the lower margin of the upper incisors to the mastoid tips/base of the skull (unless trauma when the patient is placed in a cervical collar).patient shoulders should be at equal distances from the image receptor to avoid rotation.patient positioned erect in AP position (unless trauma when the patient will be supine).This projection helps to visualize pathology relating to C3-C7 in the anatomical position, demonstrating any compression fractures, clay-shoveler fractures and herniated nucleus pulposus (HNP) 1.
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