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Current time:0:00Total duration:7:04

Adequacy of the lateral cervical spine X-ray

Video transcript

I'm here with dr. Mahadevan who is an ER physician at Stanford and and what are we looking here looking at light here well what we're going to do is look at some radiographs of the cervical spine of your neck and try to determine whether they're adequate or not and an addict what does it mean to be adequate when you have an adequate view you can see from the first vertebra all the way down to the the junction of the seventh cervical vertebra and the first thoracic vertebra I see and and we call it adequate because it means it's adequate to make a diagnosis exactly you want to be able to see the entire cervical spine so you can make sure that there's not an injury there cool cool and so what are what are we looking at over here what are we directly stare so what we're looking at is the lateral which shows essentially part of the cervical spine shows cervical vertebra one through five I see so this is just to make myself clear orient so that these are both lateral x-rays we say lateral is the x-ray from the side exactly of the person and this shows how well I know my Anatomy this this person on this actually they're facing this way they're actually facing all the way look at that oh I can see there's a little joke eh no I was just testing you yeah good job alright so the person is facing that way that this way this way is the front and you were just showing your tell you were kind of counting the different the different bones exactly you're saying this is one that's 1 2 2 3 uh-huh 4 uh-huh 5 and that's why you you hear people sometimes with back injury saying you have a problem and what were they call it in like L files l5 right yeah that's exactly about like I said okay so sorry and and actually we count even further forward from there and we look exactly at those things that look kind of look like squares those are the actual vertebra exactly right there.this exactly and although we're interested in the entire spine when we can't we kind of go down and as you can see if you look at the v square there right below that it's really hard to see these squares of 6 & 7 right we can't see anything below that it looks like was this person shoulder is blocking it 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 they shouldn't have or those lead shoulder pads I'm sorry and it's making hard to see whether there's something going on down there right now so it's really a mystery as you've shown so how do you how do you solve it how do you solve this problem if you look over at the other film it's what we call a swimmers 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 I see and you're taking it from the direction of the raised arm on the side of the ticket you take from the side and you can see this is the raised arm right over here exactly that's the raised arm exactly against the show and the other arm on the further side of the patient is down and that's what allows us to get I guess get the shoulder in a position so it doesn't block like it doesn't diss left exactly exactly I see and over here and over here it is much clearer that this person is also facing in this direction yes and and okay so let me see if so we can count this is this is number one right up here that's one one two three four five six and yeah look we already got to six we didn't see six over here and then we got seven exactly okay okay and so that you call this an adequate view for what we're trying to of the neck because now we can look at all the way through seven 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 vertebra so oh what it's like yeah it's like when those streets where they restart numbering okay all right so it becomes one again exactly is that what number that right you did and again we're looking more to the front you're you've got your numbers perfectly on every spinous process the little bump that you can feel if you press on the back your neck right but what we're really interested is that the alignment of the front of the bodies 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 if you if you just continue down right there there and it's sometimes it's difficult to see but exactly you want to see that there's alignment right in front of okay right or something here that I can't really see exactly an expert so maybe you see things like all right all right so okay so not now what do we do with this now so we've shown you that you can get a swimmers view and again show you all the way down to see 71 but on the original view as you've shown there we can't see that so what we did for this patient was get a swimmers view I see and so this is adequate and we have this other we have this other slide right over here we have this other one right over here and why is why is this one interesting this is the same patient and now we've taken that same view that we talked about before the swimmers view where this is the same patient as that this patient said not not this patient over here exactly that one looked overall pretty healthy that was that was a normal swimmers view but here is an abnormal swimmers for you in the same person same person as this one not the not the other facing in the same direction in case you want to test it yes okay good good and if you count again starting with the first okay vertebra I'll go one two this is three right here threes this one right here three out so come oh oh I see it's kind of this this whole thing is three that whole thing is to be right there exactly four five six and then seven it looks like right around there if I'm reading that if I see that there's a little possibly 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 right I'm just like that if I can I'll draw a dotted line okay fantastic looks pretty alright and as you go down look at that seven looks like a little disruption there exactly and it's pushed back and the problem is right behind those bones is your spinal cord Wow and so any kind of injury like this potentially could injure your spinal cord and lead to permanent paralysis eyes yes so this is the main thing I guess there's there's two big takeaways at least from this little short segment that we've said is that one is you 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 exactly we would call it inadequate and we would say we can't draw any firm conclusions from that that's why you wanted to get in that swimmers position raise the arm from the direction that you're looking at correct and the lower the other arm and then you can see something like this and this would 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 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 okay when in fact there's a serious problem there Wow very cool very cool thank thanks a bunch thank you