However, if there is disruption elsewhere, this should raise suspicion for a fracture. This may be incomplete between the 5 and 7 o’clock position in the normal x-ray. The body of C2 should have a visible ring on the lateral view – the Harris ring. This is also the posterior limit of the spinal canal Spino-laminar line – the junction of the laminae and the spinous processes.Posterior aspect of the vertebral body – this marks the line of the posterior longitudinal ligament and is the anterior limit of the spinal canal.Anterior aspect of the vertebral body – this marks the line of the anterior longitudinal ligament.To check alignment, four lines should be drawn You should also ensure that there is adequate exposure of the spinous processes and the soft tissues anterior to the vertebral bodies. The x-rays can be interpreted using the ABCD system:Īll plain radiographs of the spine may be assessed using the ABCD system.Īn adequate image should include the entire cervical spine from the occipital condyles to the top of T1 vertebral body. A lateral view in isolation will only detect 75% of c-spine injuries. This combination allows for good visualisation of the entire cervical spine.

Where plain radiography is indicated, three films are taken of the cervical spine: lateral, anteroposterior (AP) and open mouth (peg) views. Head injury: triage, assessment, investigation and early management of head injury in infants, children and adults. Image: Taken from NICE Clinical Guideline 56. These are based on the Canadian Cervical Spine Rules. The National Institute for Health and Clinical Excellence (NICE) have published guidance on appropriate imaging for practice in England and Wales. Not all patients presenting with neck pain following trauma will require imaging of their cervical spines, and the Emergency Physician should use a structured assessment to assist in identifying patients who require imaging. Rotational movements occur throughout the lower cervical vertebrae, but principally at the atlanto-axial joint. The principal fulcrum of flexion in the adult cervical spine occurs at C5/6.Lateral flexion occurs at the 3rd to 7th cervical vertebrae.Nodding movements occurs at the cranio-cervical joint.Subsequently the neck is susceptible to significant injury when subject to traumatic forces.ĭifferent movements take place at cervical spine levels The neck is a highly mobile structure, with an arc of 140° lateral rotation, 80° of lateral flexion, and 100° of flexion/extension in the sagittal plane.

Normal cervical spine x rays