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==Background==
[[File:HWS seitlich Annotation.jpg|thumb|Lateral film]]
''Disruption of one column is generally stable. Disruption of two or more is unstable.''
*Make sure that the C7-T1 junction is adequately visualized
**Cervical Spine Radiographic series contains 3 views
***Anteroposterior
***Lateral
***Open mouth odontoid view
*Look for alignment of four parallel vertical columns that follow a slightly lordotic curve without any step offs
**Anterior Vertebral Line: anterior to the vertebral body alternating with intervertebral disks surrouded by anulus fibrosus and anterior longitudinal ligament
**Posterior Vertebral Line: posterior to the vertebral body alternating with intervertebral disks surrouded by anulus fibrosus and posterior longitudinal ligament
**Spinolaminar Line- anterior edge of the spinous process
**Posterior Spinous Line-spinous process, nuchal ligament, interpsinous and supraspinous ligaments, and ligamentum flavum

===Pediatric===
*In patients less than 7 years old, most common mechanism for C-Spine injury was from motor vehicle crashes with injuries in the axial (occiput-C2) region
*In patients 8-15 years old, sports and motor vehicle crashes account for the most common mechanisms with injuries in the sub axial C3-C7) region. Most pediatric fractures occur higher than C3 (from proportionally larger head)<ref>http://pediatrics.aappublications.org/content/pediatrics/133/5/e1179.full.pdf </ref>
*Pseudosubluxation of C2-C3 is common (~40%) in children <8yr
**To distinguish from true dislocation or fracture:
***Draw line from cortex of post arch of C1 to cortex of posterior arch of C3 (Swischuk line)
***This line should pass through or be <2mm ant to posterior arch of C2

==Measurements (Normal)==
*Predental space (anterior aspect of odontoid to post aspect of ant ring of C1)
**Adult <3mm
**Peds <5mm
**Widening of space suggests [[Jefferson fracture|Jefferson]] burst fracture of C1
*Anterior soft tissue
**Distance between ant border of C2 and post pharynx should be <6mm in adults and peds
**Distance between ant border of C6 and post trachea should be <22 mm in adults
***Should be <14mm in children <15yr or less than width of vertebral body at each level
*Bones
**Vertebral body: Anterior height should be no more than 3mm shorter than posterior height

==Lateral View==
*'''A'''lignment
**Disruption in the anterior, posterior, or spinolaminal lines
*'''B'''ones
**Obvious fracture
**Disruption of ring of C1
**Double facet sign indicates fractured articular facet
**Loss of vertebral height
*'''C'''artilage
**Intervertebral disc space height and length should be uniform
***Narrowing: disc herniation or adjacent vertebral fracture
***Widening: posterior ligamentous injury
*'''S'''oft tissue
**Widening of the prevertebral soft tissue suggests fracture

==AP View==
*Alignment of spinous processes
*Distance between spinous processes
*Uniformity and height of vertebrae

==Odontoid View==
*Spacing of dens and lateral masses
*Lateral alignment of C1 and C2
*Uniformity of bones

==X-ray vs CT==
*Plain radiographs may be appropriate in low-risk patients
*High risk patients requiring CT:
**Closed head injury
**Neurologic deficits
**High energy trauma
**Unreliable examination
**Pain out of proportion to exam
**Inadequate plain films

==See Also==
*[[Blunt neck trauma]]
*[[Cervical spine clearance]]
*[[Canadian cervical spine rule]]
*[[NEXUS cervical spine rule]]
*[[X-ray interpretation (main)]]

==References==
<references/> 

[[Category:Neurology]]
[[Category:Orthopedics]]
[[Category:Radiology]]
[[Category:Trauma]]