Case History:
27 yo male with 2 week history of mid to lower neck pain
Contributed By:
Victor Feldman, BSc., DC
Case Presentation: Page 4 of 5

This is a good example where using a search pattern of observation called the ABC’s helps in locating the abnormality on the film. This is an acronym representing the first letters of each category in a systematic search pattern. This pattern ensures you don’t miss anything:


A= Alignment: This is where you would review roentgenometric lines and angles.


B= Bone: Review for any abnormalities in the bone density, size, shape, number of vertebrae, cortical disruption or osseous destruction.


C= Cartilage: Articluar cartilage is not normally seen on an x-ray so evaluate joint spaces, joint width, symmetry, subchondral bone, fusion, and joint congruity. Remember to look at disc spaces, facets and uncovertebral joints.


S= Soft Tissues: Look for organ displacement or enlargement, displacement of normal structures (trachea), abnormal accumulations of gas, abnormal calcifications, prevertebral soft-tissue swelling, blurring of fat planes and appearance of lung apices.


If you were reviewing the alignment using a pattern-approach, you would have found that there is disruption of the spinolaminar line at C7. This is best viewed on the lateral view (Figure 1b) showing the avulsion fracture through the spinous process. There is minimal inferior displacement of the spinous tip. Based on these findings the diagnosis is a Clay Shoveler’s fracture of C7.


Question 4: Based on the finding from the films what would your next step be? Would you begin treatment or refer for additional imaging? 

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