Hello. I am Balaji Rao, Assistant Professor of Radiology at Yale University from Neuroradiology and Emergency Radiologists section. This video is introduction to spine radiographs. First part of this video is on cervical spine and the second part is on thoracolumbar spine imaging. In each section you'll be introduced to standard views, anatomy, systematic approach, and we'll be shown examples where we will apply some of the concepts learned. Let's start with the cervical spine imaging. The standard views use in cervical spine imaging are anteroposterior or AP view, lateral view, and odontoid or open mouth view. Let's identify some anatomic structures in the lateral view. In the lateral view, the first fully formed vertebral body is the C2 vertebra, as you count down towards the thoracic spine all this makes sure that cervical thoracic junction is clearly identified. If the cervical thoracic junction is not well seen, a repeat examination or additional views will be required. Identify the C1 anterior and posterior arch. Each vertebra has a vertebral body, articular process, between the articular process you have the facet joints, the lamina, and the spinous process. Identify the intervertebral disk space between the vertebral bodies. Identify the soft tissues anterior to the vertebral bodies and the trachea. In the AP view, the upper portion of the cervical spine is usually obscured by the O-line mandiba, identify each vertebral body and the intuitive with this space between them. In the vertebral bodies the superior and inferior articular process along with the facet joint is known as articular pillar. Identify the spinous process, identify the soft tissues, lungs, and the ribs. In the open mouth or odontoid view first identify the C2 vertebral body, identify the odontoid process, identify the C1, and C2 lateral mass. The joint space between them is known as atlantoaxial joint or C1, C2 joint. Identify the mandiba. When looking at a radio-graph it is important to use a systematic approach. The approach I use is A, B, C, D, E approach that A stands for alignment, B for bodies, C for cortical outline, D for displacing, E for edges and soft tissues. Alignment of the spine in lateral view is assessed by checking specific lines. Anterior spinal line is assessed by joining anterior aspect of the vertebral bodies, posterior spinal line is assessed by joining the posterior aspect of the vertebral bodies. The spinolaminar line is assessed by joining the anterior edges of the spinous processes. These lines should have is smooth curvature. Spinal cord lies between the posterior spinal line and spinolaminar line. Also assess for the interval between the C1 and C2 called as C1, C2 space. It should be less than three millimeters in adults and less than five millimeter in children. Check the height of vertebral bodies make sure each vertebral body corresponds to its spinous process. Trace cortical outline of each word the brow for any fracture. The inter-vertebral disc space should be more or less of same height. Evaluate the thickness of soft tissues anterior to the vertebral bodies. Anterior to C3 vertebral body, soft tissue should not be more than seven millimeters and anterior to C6 vertebral body the soft tissue should not be more than 22 millimeter in adults and 14 millimeter in children less than 15 years old. Increase in the soft tissue thickness may be related to hematoma or infection. The lateral edges of virtual borders should form continuous parallel lines. The spinous process should be spaced out evenly and should form a straight line. Set the height of vertebral bodies, trace the cortical outline of each vertebra for any fracture. The inter-vertebral disc spaces should be more or less of same height the soft tissues of the neck for any emphysema and lung AP says for any pneumothorax mass or rib fractures. Lateral process should be aligned in the same plane. The space between the lateral masses of C1 and odontoid process should be equal. The lateral aspects of lateral masses should have less than one millimeter of malalignment. Identify and trace entire C2 vertebra. It is difficulty evaluate C2 C3 disk space in this view. Assess for any obvious fracture in the mandible. Let's look at some examples. I say trace the outline of C2 vertebra. I can see a gap between the odontoid process and the C2 vertebral body consistent with fractured through base of odontoid process. Let's look at a different example, I say trace the cortical outline of C2 vertebra. I see a break in the C2 lamina. This fracture is known as hangman's fracture. Let's look at the standard views and anatomy of the thoracic spine. The standard views are AP view and lateral view. Let's identify some anatomic structures in the AP view. Identify vertebral body intervertebral disc, a pedicle, spinous process, transverse process, and the ribs in the lateral view. Again identify the vertebral body, intervertebral disc, pedicle, superior, and inferior articular process and the spinous process. Let's discuss the standard use and anatomy of lumbar spine. The standard views used in lumbar spine assessment or AP view and the lateral view. In the AP view identify the vertebral body, intervertebral disc, the pedicle, the transverse process, and the spinous process. In the lateral view again identify the vertebral body, intervertebral disc, pedicle, superior, and inferior, articular process, spinous process and the neural foramen. Systematic approach of thoracolumbar spine can again be performed using A, B, C, D, E approach. Assess the anterior spinal line and posterior spinal line. This should form smooth curvature, trace each vertebral body for any high-class, trace each vertebra for any continuity too such as fraction. Identify the disc spaces, they should be of same height. Assess the soft tissues and TDN and posterior to the vertebral column. Evaluation of vertebral bodies in AP views can be again performed using A, B, C, D, E approach. Alignment of the vertebral bodies should be parallel. Vertebral body height should be symmetric. Trace the cortical outline, trace the transverse process, trace the pedicles, trace the spinous process. The disc space should be symmetric. Look at the edges and soft tissues. Now let's look at some examples. In this example you can see there is abnormal loss of height of this lower thoracic vertebral bodies. The normal vertebral body should have a rectangular. This fracture is called as compression fractures. Now let's look at a different example. This vertebral body has loss of height anteriorly. They're also fractures seen extending from posterior aspect of the vertebral body into pedicle transverse process, articular process, and spinous process. This fracture involves anterior to posterior aspect of the vertebral. This fracture is called as chance fracture. In summary when you first approach spine radio-graph, identify if it's cervical, thoracic, or lumbar spine. Identify the normal anatomic structures. Use systematic A, B, C, D approach to identify any abnormality. Thanks for your attention
