2A) without dynamic flexion and extension radiographies. The couple experienced the same car accident, and they received the similar radiological findings of a mild focal kyphosis on C4-5 and straightening of cervical spine under routine X-ray and CT scan ( Fig. The third and fourth cases were a 61-year-old man and his 56-year-old wife, who visited our emergency room with mild neck pain. Fortunately, no further instability was present by the 26-month. He initially underwent anterior cervical discectomy and fusion with plate on C5-6, and additional posterior fusion was considered if sustained instability was observed during the follow-up period. The injury of ALL was also noted on follow-up MRI. However, his neck pain persisted, and follow-up CT scan and dynamic flexion and extension radiographies presented a subluxation on C5-6. No definite acute fracture line or other deformity was visible, but only subtle high signal intensity was present at the posterior ligament complex including inter- and supraspinous ligaments on T2 fat suppression sagittal MR imaging. He had been admitted 7 weeks previously to another medical center with neck pain caused by the accident, and had been diagnosed with cervical sprain under CT scan, MR imaging, and cervical X-ray including antero-posterior and lateral views. The second case was a 46-year-old man who was transferred to our outpatient department under the impression of subluxation of the facet joint on C5-6 after a motor vehicle accident. She underwent posterior fusion on C5-6 with a lateral mass screw system and interspinous wiring ( Fig. The anterior longitudinal ligament (ALL) and intervertebral disc presented intact, and only a posterior column injury was observed. Subluxation of the facet joint on C5-6 was identified by dynamic flexion and extension radiographies after 9 weeks. She complained of intermittent neck pain and discomfort during follow-up periods at the outpatient department. We decided to prescribe for the patient a conservative treatment, because of a low possibility of instability with the above radiological examination under the Subaxial Cervical Injury Classification (SLIC) 11). The patient was found to have suspicious posterior ligament complex injuries including inter- and supra-spinous ligaments and ligamentum flavum on T2 fat suppression sagittal MR imaging ( Fig. 1C and D, including antero-posterior, lateral, and open mouth views) and CT scan ( Fig. A spinous process fracture was identified on C5 without involving lamina under routine X-ray ( Fig. She complained of left shoulder and neck pain, and was diagnosed with multiple fractures in the upper and lower extremities. if the patient is not on spinal precautions i.e.The first case was a 57-year-old woman presenting with multiple trauma caused by a rollover motor vehicle accident.use two filters, one filter anterior and one superior this will even out the density.take your time setting the patient up, rushing this projection will only cause you headaches down the road.collimate incredibly tight, because this is such a high dose projection the scatter will be at an all-time high collimation will alleviate this.This projection is regularly high stakes in resuscitation rooms and is utilized to assess critical anatomy, for those who do not have the privilege to use a superior modality such as CT 1. The technique will vary from radiographer to radiographer however, they will all have their pitfalls. This projection is technically demanding and very hard to replicate consistently. The concept of this projection is to clear the superimposing humeral heads of the cervical spine, the offset of the arms attempts to achieve this. the articular pillars and zygapophyseal joints are superimposed.the vertebral bodies are superimposed laterally.there should be a clear visualization of C7 to T1.anterior to the extent of the vertebral bodies.2.5 cm above the jugular notch at the level of T1.
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