cervical spine radiograph

Last reviewed 01/2018

The cervical spine is often imaged following major trauma or when investigating neck pain. Following major trauma, care should be taken to visualise all 7 cervical vertebrae and the C7-T1 junction, using arm traction or swimmer's views as necessary. Care should be taken to review the following features:

• Alignment of the vertebral bodies, spinal canal and spinous processes. A step in the vertebral bodies of < 25% may suggest a unifacet dislocation or >50% a dislocation of both facet joints. Angulation between vertebrae of >10% is abnormal.

• Bone contour of each vertebrae, looking for avulsion fractures of the body or spinous processes. A wedge fracture may be present if there is a difference greater than 3 millimetres between the anterior and posterior heights. Check the odontoid peg.

• Intervertebral disc space margins should be parallel.

• Soft tissue shadows. A retropharyngeal haemmorrhage or abscess may be apparent as a space greater than 5 millimetres between the lower anterior border of C3 and the pharyngeal shadow. This may be indirect evidence of C2 fracture. The space between the lower cervical vertebrae and the trachea should be less than 1 vertebral body width.