Cervical Spine Radiography


  • Approach:
    • Lateral:
    • Adequancy: all 7 c-spine vertebral including superior aspect of T1
    • Alignment: alignment/smooth in 
      • anterior vertebral line (anterior longitutinal ligament)
      • anterior spinal line (posterior longitutinal ligament)
      • posterior spinal line (ligament of flavum)
    • Bones
      • preservation of height, integrity of bony cortex, facets, spinous processes 
    • Cartilage disk spaces
      • narrowing/widening of spaces)
    • Dens
      • No breaks in outline of dens
    • Extra-Axial Soft Tissue
      • Predental space narrow (<6mm at C2) (not as large as down at C5)
    • AP (evaluate the dens and the C1-C2 alignment
      • No fracture through cortex of dens
        • type 1 – through top, type 2 – through base, type 3 – through facets
      • Smooth contour from C2 to C1, no widening of space (c/f Jefferson fxr)
  • Incomplete Documentation***
    • CT c-spine: ED preliminary interpretation: no evidence of acute traumatic bony injury.
      • Alignment: alignment/smooth in anterior vertebral line, anterior spinal line, posterior spinal line. Bones: preservation of height and integrity of bony cortex of vertebral bodies, facets, spinous processes. Cartilage disk spaces: no narrowing/widening of spaces. Dens: integrity of bony cortex of dens. Extra-Axial Soft Tissue: predental space narrow. (Radiology formal read pending. Institutional protocol in place which will alert current care team/patient for over-reads/changes/critical reads).

*This information is intended for educational purposes only and not intended for use in patient care (which requires a trained credentialed attending physician and individualization of the medical care plan to the specific patient).



  • Denis’ three column concept helps to determine whether a vertebral fracture is stable or unstable

    • I: Anterior column
      • Anterior longitudinal ligament
      • Anterior 1/2 of the vertebral body and disk
    • II: Middle column
      • Posterior 1/2 of the vertebral body and disk
      • Posterior longitudinal ligament
    • III: Posterior column
      • Facet joints
      • Ligament flavum
      • Posterior elements
    • Stablity (“Generally speaking one of the two columns (anterior and posterior) is intact, the injury is stable, if both columns are disrupted the entries unstable.
    • (From: https://www.med-ed.virginia.edu/courses/rad/cspine/fracture1.html)

  • Mnemonic: “Jefferson Bit Off A Hangman’s Thumb”



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