Lateral cervical spine X-ray

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Evaluation

Alignment

• Vertebral bodies
• Spinous processes

Bony Changes

• Bony density
• Contour
• Vertebral body height (anterior and posterior)
• Spines and transverse processes

Spaces

• Intervertebral spaces
• Interspinous spaces

Damaged tissues

• Retropharyngeal space

C1-C2

• predental space or atlas-dens interval (distance between posterior aspect of anterior arch of C1 and anterior aspect of odontoid process normally 2-2.5 mm in adults and 4-4.5 mm in children
• posterior cervical line (straight line connecting bases of C1 & C3 spinous processes should be within 2 mm of base of C2 spinous process)
• ring sign of C2

Image of atlanto-axial subluxation

C3-C7

• anterior spinal, posterior spinal and spinolaminar lines: should be smooth lines connecting anterior borders of vertebral bodies, posterior borders and bases of spinal processes
• prevertebral fat stripe: line overlying soft tissue from C1-6 should parallel anterior vertebral line
• retropharyngeal space (space between posterior pharyngeal wall and anterior border of vertebrae). Normally <7 mm in children and adults at C2. <1/2 width of the vertebral body at C3&4
• retrotracheal space (space between posterior tracheal wall and anterior inferior body C6 normally no more than 22 mm in adults and 14 mm in children <15 yrs
• disc spaces: anterior narrowing = flexion injury. Widening = extension injury
• facet joints should be parallel
• interspinous distance should decrease from C3 to C7

Image of C4-5 subluxation

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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