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The Cervical Spine
Basic Radiographs
Usually three views are obtained:
Long AP
Lateral to include top of T1 vertebral body
Open mouth AP to show C1-C2 articulation aka the Peg view
Normal lateral view
Vertebral Alignment:
Three lines or arcs can be traced:
1. Alont the anterior margins of the vertebral bodies
2. Along the posterior margins of the vertebral bodies
3. Along the bases of the spinous processes
These klines should be smooth unbroken arcs
Line 3 may sometimes show a slight step at C2, particularly in children. This posterior step should not be more than 2mm behind the smooth arc traced from C3 to C1
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The three lines or arcs
Vertrbral bodies
Those below C2 have a fairly uniform square / rectangular shape
Intervertebral Discs
These should be of uniform height.
Odontoid Peg
The dens can be visualized just behind the anterior arch of the C1 vertebra. It should be closely applied to the posterior aspect of the C1 arch. The normal distance between the bones at this point is no more than 3mm in adults and 5mm in children
Soft Tissues
The soft tissue shadow anterior to the vertebral bodies has:
a characteristic configuration
standard widths
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Normal long AP view
The spinous processes lie in a straight line
EXCEPTION: This rule may appear to be broken when bifid spinous processes are present
The distance between the spinous processes should be approximately equal. No single space should be 50% wider than the one immediately above or below
EXCEPTION : This 50% rule may be broken is spasm holds the neck in flexion
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Normal Peg view:
The lateral margins of C1 should align with the lateral margins of C2
The space on each side of the odontoid peg should be equal.
EXCEPTION : slight rotation of the neck may cause these spaces to appear unequal. However, if the lateral margins of C! and C" remain normally aligned then this assymmetry can be attributed to rotation.
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