Newer Methods for Symmetrical Roentgenography of the Intervertebral Foramina of the Cervical Spine and Optic Foramina

Abstract

Intervertebral Foramina of the Cervical Spine Narrowing of the intervertebral foramina of the cervical spine may result from fractures, dislocations, or traumatic subluxations; from bone productive changes in cases of discogenic degenerative disease, hypertrophic spondylosis, or degenerative arthrosis of the posterior articulations of the lateral intervertebral or so-called covertebral or Luschka joints; from hypertrophic arthrosis secondary to subluxations following whiplash injuries; or from fracture-dislocations of the cervical spine. Such constrictions and distortions may irritate or compress the cervical nerve roots, producing a variety of symptoms: pains radiating to the sides of the head, eyes, and ears; pains simulating arthritis, neuritis, fibrositis, bursitis, or angina pectoris (1); or a group of symptoms (2) said to result from pressure upon the vertebral sympathetic plexus, namely, deep or superficial pain in the head, face, throat, or sinuses, aphonia, vertigo, tinnitus, corneal ulcerations, flushing, lacrimation, and salivation. Roentgenographically correct and symmetrical visualization of the intervertebral foramina of the cervical spine is essential for the evaluation of these pathologic changes which may distort and constrict the foramina, with consequent pressure on the cervical nerve roots. One finds in the literature repeated warnings (3–5) relative to the importance of correct radiographic projection of the foramina and the avoidance of radiographic distortions which may be erroneously interpreted as of pathologic significance. In order to avoid the difficulties and pitfalls often encountered, the writer has constructed a revolving chair, which, when used in conjunction with an attached head damp or with a plumb line, has eliminated technical difficulties and made possible consistently satisfactory, symmetrical roentgenograms of the structures under consideration. Construction of Revolving Chair and Technic of Examination: The revolving chair is constructed as follows: A 5-ply wooden board measuring 24 × 24 inches forms the base. Attached to this at the center by a steel swivel of the “lazy Susan” type, available commercially, is a circular board, also of 5-ply wood, measuring 22 inches in diameter. The swivel measures 11 inches in diameter and is strong enough to permit easy rotation of the chair with the patient in it. A circular paper protractor is centered over the revolving board and fixed to it. The angles indicated on the protractor are then extended to the circular board and, over its edge, to the base. board, being marked off on each of these, from 1 to 180· to the right and left of the zero (0) mark. This makes it possible to rotate the patient the desired number of degrees up to 180 in either direction (Fig. 1).