Emergency Medicine

NECK INJURIES

Surgical Emergencies 227

• the retrotracheal space should be less than the width of one
  vertebral body in adults between C4/C5 and T1.
  (ii) Open-mouth odontoid view: examine the odontoid peg and dens
  of C2, and the lateral masses of C1 for evidence of fracture.
  (iii) Anteroposterior cervical spine X-ray: look for rotation of the
  vertebrae, loss of joint space and transverse process fracture.
  (iv) Cervical spine CT scan: Perform this following plain cervical
  spine X-rays if bony injury is still suspected, or to further define
  any cervical fracture and vertebral subluxation seen on those
  films. CT is particularly useful to evaluate trauma patients with:
  (a) abnormal plain films
  (b) suspicious, inadequate or incomplete plain films
  (c) neurological deficit
  (d) suspected vascular, airway, oesophageal or other soft-tissue
  injury
  (e) head injury requiring CT head scan, particularly if intubated.

(a)

1

1

2

2

3

3

4

5

6

(b)

Figure 8.1 Cervical spine x-ray in the adult
(a) Lateral view: (1) retropharyngeal space (<5 mm), (2) retrotracheal space (less than
the width of one vertebral body), (3) anterior longitudinal ligament line, (4) posterior
longitudinal ligament line, (5) spinolaminar line, (6) posterior spinal line. Lines 3, 4, 5 and
6 should all be parallel, following the normal gentle lordotic curve of the cervical spine.
The spinal cord runs between lines 4 and 5.
(b) Anteroposterior view: (1) interspinous line, (2) foramen transversarium line, (3)
transverse processes line. Lines 1, 2 and 3 should be straight in the normal neck.