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1. Prevertebral space at C3 should be less than 5 mm in adults.

Children should not exceed


two-thirds of the width of the body of C-2

Below larynx < width of C6 Body

2. Anterior alignment

A bone chip off of the inferior aspect of a vertebral body is called a tear-drop sign and is ominous
for instability and cord injury.

Odontoid fracture type 1 = stable, type 2= unstable, type 3: ominous


3. Predental space. Aduts= 3mm, peds = 4mm. Kalo melebar curiga adanya gangguan ligamen
transversum yang memegang odontoid terhadap C1, dapat menyertai fraktur C1 yang
bahaya dan unstable

4. Posterior ligament and intervertebral disk space. Hati-hati subluxation. Kalau curiga
subluxation C7-T1 obtain swimmer view
5. Arch of C1 and Atlanto-occipital alignment
6. Pedicles, laminae, lateral masses (look for hangman fracture of C2, and locked facet )
7. Spinolaminal line (important untuk lihat subluxation) buat garis dari batas posterior spinal
canal C1 ke C3, di C2 harus < 1 mm, kalau tidak ada odontoid/pedicle fracture of C2
(unstable)
8. Spinal Stenosis.Normal Widht spinal canal on x-ray is normally 13 mm
9. Spinous process angulation. Angulation of the spinous processes of 11 or more degrees
signifies fracture or ligamentous disruption.

Assess airway for foreign bodies and obstruction


Check for prevertebral swelling
Adult PEDS
Less than 6 mm at C2 1/2 to 2/3 vertebral body
Less than 22 mm at C6 distance anteroposteriorly
Look at the base of skull for:

an air-fluid level in the sphenoid sinus;


skull fractures

Confirm that the clivus points at the odontoid process


Look at rami of the mandible
Check for uniformity of:

intervertebral disk space;


density of vertebral bodies
Look at lateral masses. Is there subluxation or "perching?"
Look at junction between C7 and T1.

Check the predental space:

Adult - 3 mm or less
PEDS - 4 to 5 mm or less

Check the anterior alignment of the vertebral bodies


Check the posterior alignment of the vertebral bodies
Check the width of the spinal canal (between spinolaminar
line and posterior vertebral lines)
Check the alignment of the spinolaminar line
Check the first 3 points of the spinolaminar line for
straightness
C2 retropharyngeal space should be < 7 mm
C3 and C4 retropharyngeal space should be < 5 mm, or

Less than half the AP diameter of C3 or C4

C6 retrotracheal space should be < 22 mm in adults and < 14 mm in children (under15


years)