Cervical spine radiographs obtained after trauma should evaluate for fracture and signs of unstable ligamentous injury.
The following lines are helpful to evaluate for major traumatic malalignments of the cervical spine.
- Prevertebral soft tissues : thickening can indicate hematoma.
- Anterior vertebral line : runs along the anterior vertebral bodies, the course of the anterior longitudinal ligament.
- Posterior vertebral line : runs along the posterior vertebral bodies, the course of the posterior longitudinal ligament.
- Spinolaminar line : posterior margin of the spinal canal.
- Posterior spinous line : runs along the tips of the spinous processes.
Odontoid or “open-mouth” views are helpful in the evaluation of the dens (fractured) and atlantoaxial joint alignment.
Cervical spine fractures typically occur as a result of hyperflexion, hyperextension, or compression. Fracture patterns and their potential for cord injury will often fall into one of these mechanistic categories.
For more information about cervical spine trauma and mechanisms check out: https://www.arrs.org/shoparrs/products/s12p_sample.pdf
Each vertebral body should be similar in height to the adjacent vertebral body. Wedging/height loss may indicate compression fracture. As with any fracture, vertebral body fractures can be detected by cortical step-off and attention should be paid to the corners of the vertebral bodies.
- Compression fracture of C7 vertebral body with approximately 30 percent anterior vertebral body height loss.
- Minimal retropulsion of the posterior superior vertebral body without listhesis.
- Compression fracture of C7 vertebral body.
- Recommend immobilization and emergent CT for further characterization.
Each facet joint should also resemble the adjacent levels. Asymmetric widening of the facet joints may suggest injury. Abnormal alignment of the facets may signify a rotational abnormality such as perched or even jumped facets.
- Marked anterolisthesis of C4 on C5 with focal kyphotic angulation and jumped bilateral facets.
- Probable fractures of C4 vertebral body inferior endplate and C5 superior endplate.
- Moderate prevetebral soft tissue swelling.
- C4-C5 facet dislocation with jumped/locked appearance and likely spinal cord injury.
- Recommend comparison with MRI for further assessment.
Example report negative for traumatic injury:
- Patient in neck brace. The cervical spine is visualized to the level of C7. The alignment of the cervical spine is within normal limits. There is no evidence of fracture.
- No prevertebral soft tissue swelling. Lung apices are clear.
- No traumatic malalignment. Radiographic sensitivity for cervical spine injury is limited. Recommend cross-sectional evaluation if suspicion for injury persists.