Cervical | Neurosurgery Basics


X-rays  —  CT  —  MRI

The following pages cover C-spine imaging:

X-ray: the first study to order for trauma and non-radiating neck pain.

CT: the study to evaluate fracture, especially of C1, C2, and C7-T1.

MRI: the study to evaluate radicular or myelopathic symptoms.

Cervical MRI: A Systematic Reading

The T2 sagittal and axials are the money shots in the neck. First, look at the sagittals. Number the vertebrae, starting with the unique C2 with its odontoid process (dens) towering high from its body. Going down from C3, each vertebra looks like a rectangle.

Cervical X-rays: A Systematic reading

The most commonly ordered spine radiographs, x-rays of the cervical spine are used to evaluate trauma and everyday neck pain. X-rays are also useful for evaluation of the postoperative patient. The three essential views are AP, Lateral, and Odontoid.

When the Pain Is Worse than Films

Sometimes a patient will have excruciating pain, and rather bland films. Then your job is to make sense of the mismatch.

Brown-Sequard Syndrome: Hemisection of the Cord

Injury to half the spinal cord, or “hemisection of the cord,” can occur with trauma, tumor, or disc herniation. But most often it is seen in textbooks and in med school exams! The injury produces a unique constellation of findings: