Pediatric emergency medicine trisk 3593 3593
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FIGURE 112.16 The ABCS of radiographic cervical spine interpretation.
When evaluating a lateral cervical spine radiograph, the clinician must ensure
that C1–C7 are included as well as the C7–T1 junction. An adequate open-mouth
view is often technically difficult to obtain in young children and those who are
intubated. A systematic approach should be used when evaluating radiographs of
the cervical spine. The ABCS method is a useful approach ( Fig. 112.16 ).
Alignment is assessed as demonstrated in Figure 112.17 , keeping in mind that the
spinal cord lies between the posterior spinal line and the spinolaminar line. These
lordotic curves may not be present in children younger than 6 years, those on hard
spine boards or on cervical collars, or those with cervical neck muscle spasm.
Gross malalignment should be detectable with this assessment. Be aware of
physiologic pseudosubluxation of C2 on C3 and less frequently, C3 on C4. To
discern whether there is pseudosubluxation or traumatic injury, determine the
distance between the posterior arch of C2 and the spinolaminar line; if it is greater
than 2 mm, true injury should be considered ( Fig. 112.18 ).
