If a lateral cervical spine X-ray has been requested for another indication (e.g. from C4 onwards the pre-vertebral soft tissue should be no larger than the width of one whole vertebral body.above C4 the pre-vertebral soft tissue should be no larger than one-third of the adjacent vertebral body in width.It should be noted that this area naturally gets wider around the level of C4 so two different acceptable widths are used: Any widening of this space may represent a pre-vertebral haematoma and should significantly raise suspicion of a cervical fracture. Soft tissue appears as a light grey opacity on cervical spine X-rays, located between the vertebral bodies and the darker-grey area that represents the trachea. Pre-vertebral (i.e the area directly anterior to the vertebral bodies) soft tissue is best assessed using a lateral view. However, if you suspect disc pathology (e.g disc herniation) from the history/examination (cervical radiculopathy with sensory/motor disturbance at a certain spinal level), this often wouldn’t be clearly seen on a cervical spine X-ray and would be better investigated with an MRI scan. Intervertebral discs should be roughly similar in height throughout the cervical spine, with no obvious loss of height at any point in the disc. Lateral C-spine X-ray with normal outlines of the vertebra compared with a “teardrop” fracture of C5 on the right 3 Cartilage (i.e discs) A fracture of the lateral masses of C2 would be visible on X-ray as a disruption of the C2 bony ring. Inside the body of C2, there is a radio-dense (“whiter”) ring of bone, which represents the lateral masses of C2. Make sure you include this in your scan of the cortices of each bone. The odontoid peg: as well as on the odontoid view, the peg can usually be viewed on lateral views as an increased area of density within the body of C1. If an abnormality is identified, you should note it and then continue to follow your systematic approach until all relevant bones have been assessed. A common pitfall is to stop searching once you have found one abnormality. In all three of the previously discussed views, you should carefully inspect the cortex (outer white edge) of each bone in turn, making sure you are systematic (e.g. A step in the lines, indicating a “Hangman’s fracture” – bilateral laminar and pedicle C2 fracture with anterolisthesis of C2 on C3 2 Bones Asymmetry of the space between the peg and the lateral mass of C1 may indicate fracture or dislocation of the odontoid peg.įigure 4. To do this, inspect and compare the space between the peg and the lateral mass of C1 on each side. You can also use this view to assess the odontoid peg to make sure it is aligned with the lateral masses of C1. Irregularities in the areas where these lines intersect may indicate misalignment of the lateral masses of C1 and C2 (e.g. The odontoid/open-mouth view has several intersecting lines which are sometimes referred to as a “meeting of corners”. AP view C-spine X-ray with yellow (lateral) and blue (spinous process) lines added 1 Odontoid/open-mouth view The spinous process line runs down through each spinous process from C1 to C7 (represented by the blue line in the image below). The two lateral lines of the AP view run down either side of the vertebral bodies (represented by the yellow lines in the image below). The green channel is the space occupied by the spinal cord. Lateral cervical spine X-ray with red (spinolaminar), orange (posterior longitudinal) and yellow (anterior longitudinal) lines added. The spinolaminar line runs along the anterior edge of the spinous processes (at the junction of the spinous process and the laminae). The posterior longitudinal line runs along the posterior surface of the vertebral bodies. The anterior longitudinal line runs along the anterior surface of the vertebral bodies. There are multiple lines you need to assess across each of the three radiograph views which should run uninterrupted in healthy individuals. AdequacyĬheck the radiograph’s adequacy to ensure you are able to clearly see all relevant structures (you should be able to see from C1 down to the C7/T1 junction). InterpretationĪ structured approach to cervical spine X-ray interpretation is discussed below. If you are struggling to see down to the level of C7/T1, a fourth “ swimmer’s view” can be requested. Typically there are three standard views provided when a cervical spine X-ray is performed, these include a lateral, antero-posterior (AP) and odontoid/open-mouth view. You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of radiology interpretation stations ✨ Acquire all necessary views

Oblique cervical spine x ray anatomy