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There are many grading systems for degeneration of intervertebral discs and facet joints in the cervical and lumbar vertebrae, of which the following radiographic systems can be recommended in terms of interobserver reliability: [1]
Those with neck pain only without any positive neurological findings usually do not require an x-ray of the cervical spine. For those with chronic neck pain, a cervical spine x-ray may be indicated. There are various ways of doing cervical spine X-rays such as anteroposterior (AP) view, lateral view, Swimmer's view, and oblique view.
In some, the x-ray findings may correspond to symptoms of back stiffness with flexion/extension or with mild back pain. [2] Back pain or stiffness may be worse in the morning. [4] Rarely, large anterior cervical spine osteophytes may affect the esophagus or the larynx and cause pain, difficulty swallowing [5] [6] or even dyspnea. [7]
Awareness of normal anatomic features is crucial for the interpreter to be able to detect subtle signs of fracture. Fat pads should be carefully examined for convexity, which implies joint effusion (e.g., in the hip and elbow). However, the radiographic technique (positioning in particular) must be optimal for this evaluation to be valid.
Generally, radiation therapy should be delivered as close as practical to the time of surgery. A dose of 7-8 Gray in a single fraction within 24–48 hours of surgery has been used successfully. Treatment volumes include the peri-articular region, and can be used for hip, knee, elbow, shoulder, jaw or in patients after spinal cord trauma.
Because intra-articular fractures cause a joint effusion, the dorsal fat pad sign is a reliable parameter for diagnosis of elbow fractures. [17] If a joint effusion is depicted in the ultrasound, two-plane X-ray imagery is necessary to diagnose the fracture. The standard procedure is the elbow-SAFE algorithm. [18]
In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants. Spinal fusion was one of the five most common OR procedures performed in every age group except infants younger than 1 year and adults 85 years and older. Laminectomy was common among adults aged 18–84 years.
A 64-slice CT with reconstructions does not entirely rule out ligamentous injury leading to instability, but is a practical means of identifying the majority of C-spine injuries in obtunded patients. MR C-spine has frequent false-positives, limiting its usefulness. [citation needed] In these cases, a consultation with a Spine Surgery specialist ...