Normal Cervical Spine X-ray
The cervical spine is the part of the spine that is present in the neck region. It is formed by first 7 vertebrae of the spine numbered from C1 to C7.
The spine begins with C1 vertebra which is also called Atlas. Next vertebra is Axis.
Seventh cervical vertebra or C7 is also called vertebra prominens.
It must be noted that normal cervical spine x-rays do not exclude significant injury.
The lateral view is often the most informative image. In a lateral view first thing to look for is if the cervical spine is adequately covered in the view. Next, alignment of the vertebrae is looked for. Normal cervical spine x-ray would reveal a smooth lordotic curve and any loss of lordosis indicates spasm.
Vertebrae are studied for smooth cortical outline and height. Disc spaces are looked for any reduction of space. Prevertebral shadow is studied for any increase in width.
A normal cervical spine x-ray – Lateral View
Coverage
All vertebrae are visible should be visible from skull base to the top of T1 is considered adequate.
If T1 is not visible then a repeat image with the patient’s shoulders lowered. Otherwise, a swimmer’s view may be acquired.
Alignment
Anterior line or the line of the anterior longitudinal ligament [line formed by connecting anterior margins of cervical vertebral body], the posterior line the line of the posterior longitudinal ligament formed by connecting posterior margins of cervical vertebrae] and the spinolaminar line or the line formed by the anterior edge of the spinous processes are checked for continuity.
Vertebrae
Cortical outline of all the bones should be checked for fractures.
Disc spaces
The vertebral bodies are spaced apart by the intervertebral discs – not directly visible with X-rays. These spaces should be approximately equal in height increase as we come lower down.
Prevertebral soft tissue
Some fractures cause widening of the prevertebral soft tissue due to the prevertebral hematoma. The width is measured between the anterior line and anterior margin of soft tissue visible on the x-ray.
– The normal prevertebral soft tissue is narrow down to C4 and wider below
– Above C4 -1/3rd vertebral body width
– Below C4 – 100% vertebral body width
This x-ray shows a normal cervical spine. The present x-ray shows vertebra from C1 to C7.
The view in the present picture is lateral view.
As you can view it, normal cervical spine appears lordotic. That means the anterior part of the spine appears convex and posterior concave.
Normal Cervical Spine Xray – AP View
Coverage
The AP view should cover the whole cervical spine and the upper thoracic spine.
Alignment
The lateral edges of the cervical spine are aligned.
Bone
Check for bony integrity to rule out fractures
Spacing
The spinous processes are in a straight line and spaced approximately evenly.
In diseases or spasm of the cervical spine, this lordosis of the normal cervical spine is lost.
Most common of these causes a change in curvature is cervical spondylosis.
For examination of the cervical spine, both anteroposterior and lateral views are required. Though both the views are important, the lateral view is more informative.
Special view radiographs may be required in many cases for proper diagnosis of the disease.
Cervical spine x-ray can be taken in standing position or lying down on the table.
The first method is done routinely on ambulatory patients in the outpatient department. Lying down method is done in cases of injury or patients who cannot stand.
