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Course: Health and medicine > Unit 8
Lesson 12: Miscellaneous topicsAdequacy of the lateral cervical spine X-ray
Dr. Mahadevan from Stanford School of Medicine explains adequacy for lateral cervical (neck) x-rays. Created by Sal Khan.
Want to join the conversation?
- Any info on the kind of treatment that is going to be used? Heading to Chiropractic school in the fall. Spinal x-rays are going to be of special interest to me!(4 votes)
- As a practicing chiro, I would also caution adjusting this neck with a conventional HVLA (high velocity low amplitude) type of adjustment, especially in that C6-C7 area. Obviously you wouldn't want to risk moving that C6 even further forward, however depending on patient tolerance and doctor skill level, adjusting C7 anterior and/or C6 posterior with an Activator or other adjusting device could help tremendously!(6 votes)
- what exactly is swimmers view(5 votes)
- It's an x-ray taken with the one of the patient's arms raised while the other arm is lowered more than normal(4 votes)
- what does he mean by "swimmer's view"?(4 votes)
- Swimmers view is when the person rises one arm, while at the same time dropping the opposite shoulder. (The position of the arms of a Free-style swimmer)(5 votes)
- What specialist would treat this patient?(3 votes)
- maybe an orthopedic specialist? I am not sure, he said a spine specialist.(4 votes)
- how does an injury to spinal cord c3 affect sensorimotor function(4 votes)
- It depends on the severity of the injury to the spinal cord, and if there is compression of the nerve roots exiting the cord. However, this sort of injury could potentially be quite dangerous, as the nerve roots exiting C3 form a part of the phrenic nerve, which is responsible for providing motor innervation to the diaphragm (the main muscle we use to inspire)(3 votes)
- What if the patient is unable to get into the swimmer's position?(4 votes)
- you could always do a CT scan instead. which is a more advanced x- ray that can see more and around(2 votes)
- Just for clarification..when looking at an x ray from a swimmer's view, is the arm closest to the viewer's eye raised or lowered?(3 votes)
- The arm closest to the eye is raised.
In the "swimmer's view" picture you stand at the left hand side of the patient and look at the left arm, which is raised up.(3 votes)
- Do you have more clips that can help other Radiologic Technologist to keep their studies up, dealing with all kinds of x-rays and x-ray information.(2 votes)
- Is there anterior wedging of C6 vertebral body in the left-most picture? Is this is a correlation often seen with c6/c7 disc herniation?(2 votes)
- Do spine x-rays help in the same way that MRI's do? And are x-rays used to diagnose neurological conditions?(2 votes)
- x-ray's can be helpful in diagnosing neurological conditions if they are being caused by a bone malformation of some sort; in the case of thoracic outlet syndrome, if someone has a cervical vertebrae, a rib coming off of c7 (normal from T1) this could cause compression of structures coming out of the thoracic outlet like the subclavian vein, artery, or brachial plexus as it is situated between the anterior and medial scalene muscles.(2 votes)
Video transcript
SAL KHAN: I'm here
with Dr. Mahadevan, who's an ER physician
at Stanford. And what are we looking at here? DR. MAHADEVAN: Well,
what we're going to do is look at
some radiographs of the cervical
spine or of your neck and try to determine whether
they're adequate or not. SAL KHAN: And what does
it mean to be adequate? DR. MAHADEVAN: When you
have an adequate view, you can see from
the first vertebra all way down to the junction of
the seventh cervical vertebra and the first thoracic vertebra. SAL KHAN: I see. And we call it
adequate because it means it's adequate
to make a diagnosis. DR. MAHADEVAN: Exactly. You want to be able to see
the entire cervical spine, so you can make sure that
there's not an injury there. SAL KHAN: Cool, cool. And so what are we
looking at over here? What are we directly staring at? DR. MAHADEVAN: So what we're
looking at is the lateral, which shows essentially
part of the cervical spine, shows cervical vertebra
one through five. SAL KHAN: I see. So just to make myself clear. So these are both
lateral x-rays. And we say, lateral. It is actually from
the side of the person. And this shows how
well I know my anatomy. This person, on this x-ray,
they're facing this way? DR. MAHADEVAN: They're
actually facing the other way. SAL KHAN: See, look at that. I can see, there's a little jaw. OK. No, I was just testing you. Good job. All right. So the person is
facing that way. This way is the front. And you were just
showing-- you were kind of counting
the different bones. DR. MAHADEVAN: Exactly. SAL KHAN: And you were
saying, this is one. DR. MAHADEVAN: That's one. SAL KHAN: Two. DR. MAHADEVAN: Two. SAL KHAN: Three,
four, five, and that's why you hear people, sometimes,
with back injuries saying, I have a problem in--
what do they call it? DR. MAHADEVAN: L5 is one. SAL KHAN: Right. That's what they're
talking about, like that. OK, so sorry. DR. MAHADEVAN: And actually,
we count even further forward from there. And we look exactly at those
things that kind of look like squares. Those are the actual vertebra,
exactly, right there. SAL KHAN: This. DR. MAHADEVAN: Exactly. And although we're interested
in the entire the spine, when we count. We kind of go down. And as you can see, if you
look at the fifth square there, below that it's
really hard to see the squares of six and seven. SAL KHAN: Right, we can't
see anything below that. And looks like what is
this person's shoulder is blocking it. DR. MAHADEVAN: Exactly. You can see that that
big white thing there is the shoulder that's
gotten in the way. And it's making it hard to see. SAL KHAN: They shouldn't have
worn those lead shoulder pads. DR. MAHADEVAN: [LAUGHING]
And it's making it hard to see whether there's
something going on down there right now. So it's really a
mystery, as you've shown. SAL KHAN: So how do
you solve this problem? DR. MAHADEVAN: If you look
over at the other film, it's what we call
a swimmer's view. And what we've asked
the patient to do is raise one arm up
and lower the other. And in doing so, you kind of
clear that lower cervical spine and allow better visualization
of the entire spine. SAL KHAN: I see. And you're taking it from the
direction of the raised arm, on the side of raised arm. DR. MAHADEVAN: You
take it from the side. And you can see. SAL KHAN: This is the
raised arm right over here. DR. MAHADEVAN: Exactly,
that's the raised arm. SAL KHAN: I see. And the other arm on the further
side of the patient is down. And that's what allows us to get
to the shoulder in a position, so it doesn't block like
it does in this left view. DR. MAHADEVAN: Exactly, exactly. SAL KHAN: I see. And over here, it
is much clearer that this person is also
facing in this direction. And OK. So let me see. So we can count. This is number
one right up here. DR. MAHADEVAN: That's one. SAL KHAN: One, two, three,
four, five, six-- yeah, we already got to six. We didn't see six over here. And then we got seven. DR. MAHADEVAN: Exactly. SAL KHAN: OK. And so you would call this is
an adequate view for what we're trying-- of the neck, because
now we can look at all the way through seven. DR. MAHADEVAN: Absolutely. We can get all the
way down to seven. And ideally, you want to
see the top of one, which comes-- actually, in
this counting system, we go one through seven. And then we start
back at one again, because we're starting with
the thoracic vertebrae. SAL KHAN: Oh, look at that. It's like with those streets,
where they restart numbering. And you can't find it. All right. So it becomes one again. DR. MAHADEVAN: Exactly. SAL KHAN: Did I
number that right? DR. MAHADEVAN: You did. And again, we're looking
more to the front. You've got your
numbers perfectly on every spinous process, the
little bump that you can feel, if you press on the
back of your neck. But what we're really
interested is the alignment of the front of the
vertebral bodies. SAL KHAN: So this is one. This is two, three,
four, five, six, seven. You want to look
at the top of one. Where's the top of one? DR. MAHADEVAN: If you just
continue down right there. And it sometimes is
difficult to see. But exactly, you want to
see that there's alignment right in front of-- SAL KHAN: OK. I'll assume that
there's something here that I can't really see. But you're an expert. So maybe you see
things that I don't. All right. OK, so now what do
we do with this? DR. MAHADEVAN: Now,
we've shown you that you can get
a swimmer's view. And it can show you all
the way down to C7, T1. But on the original
view, as you've shown, we can't see that. So what we did for this patient
was get a swimmer's view. SAL KHAN: I see. So this is adequate. And we have this other
slide right over here. We have this other
one right over here. And why is this one interesting? DR. MAHADEVAN: This
is the same patient. And now we've taken
that same view that we talked about
before, the swimmer's view, where you've got-- SAL KHAN: This is
the same patient as this patient right over
here, not this patient over here on the right. DR. MAHADEVAN: Exactly. SAL KHAN: Because that one
looked overall pretty healthy. DR. MAHADEVAN: That was
a normal swimmer's view. But here is an abnormal
swimmer's view. SAL KHAN: It's the same person? DR. MAHADEVAN: Same person-- SAL KHAN: As this one, not
the other swimmer's view. DR. MAHADEVAN: Facing
in the same direction, in case you want
to test me again. SAL KHAN: OK, good. DR. MAHADEVAN: And
if you count again, starting with the
first vertebra. So we go one-- SAL KHAN: Two-- this
is three right here? DR. MAHADEVAN: Three
is this one right here. SAL KHAN: Three, oh, it's
a kind of a-- oh, I see. This whole thing is three? DR. MAHADEVAN: That whole thing
is three right there, exactly. SAL KHAN: Four, five,
six, and then seven, it looks like
right around there, if I'm reading that,
if I see that properly. It's a little darker there. DR. MAHADEVAN: And the key
important finding there is, that as you draw a
line along the anterior or the front of all
those vertebral bodies, if you were to connect
them just like that. SAL KHAN: I'll
draw a dotted line. DR. MAHADEVAN: Fantastic. SAL KHAN: It looks
pretty all right. DR. MAHADEVAN: And
as you go down-- SAL KHAN: Oh, look
at that, at seven, looks like a little
disruption there. DR. MAHADEVAN: Exactly,
and it's pushed back. And the problem is,
right behind those bones is your spinal cord. And so in any kind of an
injury like this, potentially, could injure your spinal cord
and lead to permanent paralysis or weakness. SAL KHAN: I see. So this is the main thing. I guess, there's
two big takeaways, at least from this little
short segment, that we've set. One is, you've got to make sure
that you have the information to make a diagnosis on. So for example, this
right over here, you couldn't even
do something useful, because you're not able to
see the number six and number seven. DR. MAHADEVAN: Exactly, we
would call it inadequate. And we would say, we can't draw
any firm conclusions from that actually. SAL KHAN: And
that's why you want them to get in that
swimmer's position, raise the arm from the direction
that you're looking at. DR. MAHADEVAN: Correct. SAL KHAN: And they'll
lower the other arm. And then you can see
something like this. And this right over here
is cause for trouble, because now you can go
all the way down to seven. And you can actually see
that they're not aligned. DR. MAHADEVAN: Absolutely. And so this is
someone you wouldn't let get out of your
emergency department without seeing a specialist,
a spine specialist. Whereas if you didn't
have that view, you might be falsely reassured
that everything was OK, when in fact, there's a
serious problem there. SAL KHAN: Very cool, very cool. Thanks a bunch. DR. MAHADEVAN: Thank you.