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Radiography versus Spiral CT in the Evaluation of Cervicothoracic Junction Injuries in Polytrauma Patients Who Have Undergone Intubation1

Louise M. E. Jelly, FRCR, David R. Evans, MB,BS, Marina J. Easty, FRCR, Timothy J. Coats, FRCS and Otto Chan, FRCR

1 From the Departments of Radiology (L.M.E.J., D.R.E., M.J.E., O.C.) and Accident and Emergency (T.J.C.), The Royal London Hospital, Whitechapel, London E1 1BB, England. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received February 9, 2000; revision requested March 28 and received April 25; accepted April 28. Address correspondence to L.M.E.J. (e-mail: louisejelly@hotmail.com).



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  		Figure 1. Cross-table lateral radiograph shows an obvious C7 vertebral body fracture (arrow).

 


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  		Figure 2. Cross-table lateral radiograph demonstrates a crush fracture of C6 (arrow).

 


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  		Figure 3a. (a) Cross-table lateral radiograph shows C2 and C7 spinous process fractures (arrows). (b) Spiral CT scan obtained at the level of C2 demonstrates spinous process and right lamina fractures (arrows). (c) Spiral CT scan obtained at the level of C7 helps confirm the spinous process fracture (arrow).

 


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  		Figure 3b. (a) Cross-table lateral radiograph shows C2 and C7 spinous process fractures (arrows). (b) Spiral CT scan obtained at the level of C2 demonstrates spinous process and right lamina fractures (arrows). (c) Spiral CT scan obtained at the level of C7 helps confirm the spinous process fracture (arrow).

 


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  		Figure 3c. (a) Cross-table lateral radiograph shows C2 and C7 spinous process fractures (arrows). (b) Spiral CT scan obtained at the level of C2 demonstrates spinous process and right lamina fractures (arrows). (c) Spiral CT scan obtained at the level of C7 helps confirm the spinous process fracture (arrow).

 


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  		Figure 4. Spiral CT scan obtained at the level of T1 demonstrates a right transverse process fracture (arrow) that was not seen on conventional radiographs (not shown).

 


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  		Figure 5a. (a) Cross-table lateral radiograph demonstrates spinous process and lamina fractures of C5 and C6 (arrows). C7 appears normal. (b, c) On left (b) and right (c) supine oblique radiographs, the cervicothoracic junction is well demonstrated. (d) Spiral CT scan obtained at the level of C5 demonstrates left lamina and spinous process fractures (arrow). (e) Spiral CT scan shows an unsuspected fracture of the right pedicle of C7 extending into the vertebral body (arrow).

 


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  		Figure 5b. (a) Cross-table lateral radiograph demonstrates spinous process and lamina fractures of C5 and C6 (arrows). C7 appears normal. (b, c) On left (b) and right (c) supine oblique radiographs, the cervicothoracic junction is well demonstrated. (d) Spiral CT scan obtained at the level of C5 demonstrates left lamina and spinous process fractures (arrow). (e) Spiral CT scan shows an unsuspected fracture of the right pedicle of C7 extending into the vertebral body (arrow).

 


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  		Figure 5c. (a) Cross-table lateral radiograph demonstrates spinous process and lamina fractures of C5 and C6 (arrows). C7 appears normal. (b, c) On left (b) and right (c) supine oblique radiographs, the cervicothoracic junction is well demonstrated. (d) Spiral CT scan obtained at the level of C5 demonstrates left lamina and spinous process fractures (arrow). (e) Spiral CT scan shows an unsuspected fracture of the right pedicle of C7 extending into the vertebral body (arrow).

 


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  		Figure 5d. (a) Cross-table lateral radiograph demonstrates spinous process and lamina fractures of C5 and C6 (arrows). C7 appears normal. (b, c) On left (b) and right (c) supine oblique radiographs, the cervicothoracic junction is well demonstrated. (d) Spiral CT scan obtained at the level of C5 demonstrates left lamina and spinous process fractures (arrow). (e) Spiral CT scan shows an unsuspected fracture of the right pedicle of C7 extending into the vertebral body (arrow).

 


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  		Figure 5e. (a) Cross-table lateral radiograph demonstrates spinous process and lamina fractures of C5 and C6 (arrows). C7 appears normal. (b, c) On left (b) and right (c) supine oblique radiographs, the cervicothoracic junction is well demonstrated. (d) Spiral CT scan obtained at the level of C5 demonstrates left lamina and spinous process fractures (arrow). (e) Spiral CT scan shows an unsuspected fracture of the right pedicle of C7 extending into the vertebral body (arrow).

 


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  		Figure 6a. (a) Cross-table lateral radiograph shows spinous process fractures of C4, C5, and C6 (arrowheads). The C7-T1 space is also seen. (b) Spiral CT scan helps confirm the spinous process fracture of C5 (arrowhead). (c) Spiral CT scan obtained at the level of T1 shows an unsuspected fracture of the left first rib (arrow).

 


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  		Figure 6b. (a) Cross-table lateral radiograph shows spinous process fractures of C4, C5, and C6 (arrowheads). The C7-T1 space is also seen. (b) Spiral CT scan helps confirm the spinous process fracture of C5 (arrowhead). (c) Spiral CT scan obtained at the level of T1 shows an unsuspected fracture of the left first rib (arrow).

 


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  		Figure 6c. (a) Cross-table lateral radiograph shows spinous process fractures of C4, C5, and C6 (arrowheads). The C7-T1 space is also seen. (b) Spiral CT scan helps confirm the spinous process fracture of C5 (arrowhead). (c) Spiral CT scan obtained at the level of T1 shows an unsuspected fracture of the left first rib (arrow).

 


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  		Figure 7a. (a) Cross-table lateral radiograph demonstrates no fracture. (b) Spiral CT scan obtained at the level of T2 shows an unsuspected fracture of the right second rib (arrowheads).

 


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  		Figure 7b. (a) Cross-table lateral radiograph demonstrates no fracture. (b) Spiral CT scan obtained at the level of T2 shows an unsuspected fracture of the right second rib (arrowheads).

 




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