Cervical Spine (Standard series)

Question 1

What does the standard Cx series consist of?

Answer 1

Neutral lateral.
AP lower cervical (APLC).
APOM (AP open mouth).

Question 2

What does the marker indicate in a lateral Cx shot?

Answer 2

It indicates which shoulder is closest to the film.

Question 3

In a lateral cervical, what are the 5 cervical lines that need to be assessed?

Answer 3

Pre-vertebral tissue soft tissue line  
Anterior vertebral bodies
Posterior vertebral body line
Spinolaminar junction line
Spinous process interspaces

Question 4

What is the rule of 2’s and 6’s?

Answer 4

At C2 < 6 mm

At C6 < 22 mm

Question 5

What are the landmarks for the posterior vert body line?

Answer 5

Superior and inferior body corners.

Question 6

What is the atlantodental interspace?

How big should the space be?

Answer 6

It’s the space between the posterior aspect of C1 anterior tubercle and the anterior aspect of odontoid process.
Adults: < 3 mm
Children: < 5 mm

Question 7

What is McGregor’s Line?

Answer 7

Posterior-superior margin of hard palate to inferior-most surface of the occiput.
Tip of dens should be < 10 mm above McGregor’s Line.

Question 8

What air shadows will be observed in a lateral cervical?

Answer 8

Pharyngeal
Laryngeal
Tracheal

Question 9

What structures are visualized on an AP Lower Cx?

Answer 9

C3-C7 vertebral bodies.
Posterior elements (SPs and articular pillars are most consistent, other structures are more oblique).
Uncinate processes of uncovertebral joint spaces.
Soft tissues of neck.

Question 10

What is laryngeal constriction?

Answer 10

Narrow when patient is holding their breath, open when patient is breathing.

Question 11

What would make lateral margins on an AP lower Cx more difficult to visualize?

Answer 11

Superimposition of posterior elements.

Question 12

On an AP lower Cx, what structure can you look at to find rotation?

Answer 12

Clavicles

Question 13

What does a measurement of the ADI an indicator of?

Answer 13

Indicates rupture of transverse ligament

Question 14

Where is the ADI measured?

Answer 14

Midpoint of posterior margin of anterior tubercle of C1 to nearest point on anterior margin of odontoid process

Question 15

In what direction do the Cx TP’s point?

Answer 15

Inferiorly

Question 16

What is a lateral cervical view an indicator of?

Answer 16

Canal stenosis (45)

Question 17

Where is George’s line?

Answer 17

Posterior body margin line (44)

(George is gay, and likes it in the “posterior body”

Question 18

What are the structures best visualized on an APOM?

Answer 18

C0-C1 articulation.
C1-C2 joint space.
Lateral masses of arches of C1 (TP's of C1).
Odontoid process.
paraodontoid notches.
Body of C2.
Skull, mandible, and dental structures.

Question 19

On an APOM, what soft tissue structures need to be accounted for?

Answer 19

Tongue shadow and superimposition of teeth/dental appliances.

Question 20

What would a Cervical Oblique indicate?

Answer 20

Radicular symptoms, suspected dislocation, and further assessment of posterior elements (pedicles, lamina, pillars).

Question 21

T/F: The entire cervical spine is visible on Cx Obliques.

Answer 21

True.

Question 22

Which IVF is viewed on RPO/LAO?

Answer 22

Left IVF

ASSPO

Question 23

Which IVF is viewed on LPO/RAO?

Answer 23

Right IVF.

ASSPO

Question 24

Describe Chamberlain’s line:

Answer 24

Goes from posterior hard palate to posterior foramen magnum.

Dens should not project above this line (3 mm above may be normal).

Question 25

Describe the Atlantodental Interval:

Answer 25

Goes from midpoint of posterior margin of anterior tubercle of C1 to nearest point on anterior margin of odontoid process.
Normal is < 3 mm in an adult (< 5 mm in a child).
Indicates rupture of transverse ligament (C1-C2 instability).

Question 26

Describe George’s line:

Answer 26

Posterior body margin line.
Goes along posterior aspect of the vertebral bodies, extrapolate across disc space.
Offset indicates antero or retrolisthesis.
Translation > 4 mm b/w two views may indicate instability.

Question 27

Describe the Spinolaminar Junction Line:

Answer 27

Posterior cervical line.

Offset indicates antero or retrolisthesis.

Question 28

Describe the Sagittal Dimension of the Cervical Spinal Canal:

Answer 28

Posterior surface of midvertebral body to spinolaminar junction.
Minimums (varies by level): 
C1 - 16 mm
C2 - 14 mm
C3 - 13 mm
C4-C7 - 12mm
Indicator of canal stenosis

Question 29

Describe Atlantoaxial Alignment:

Answer 29

“X” drawn with lines from one C0-C1 joint through opposite C1-C2 gives general idea of symmetry, rotation at C1-C2.
Lateral mass of atlas should not overhang lateral margin of C2 superior faces (>1mm).

Question 30

Describe Coronal Dimensions of the Cervical Spine Interpediculate Distance:

Answer 30

Measure shortest distance b/w inner cortical margins of pedicles at given segment; vary by spinal level; evaluates for stenosis.

Question 31

Describe Cervical Gravity Line:

Answer 31

Vertical line drawn through the apex of the odontoid process should pass through the seventh cervical vertebral body.

Question 32

Describe the Angle of Cervical Curve:

Answer 32

2 lines are drawn, one through and parallel to the inferior endplate of the seventh cervical body, the other through the midpoints of the anterior and posterior tubercles of the atlas.
Construct perpendiculars and measure the angle.
Normally 35-45 degrees.

Question 33

Describe Prevertebral Soft Tissue:

Answer 33

Space measured b/w the vertebral bodies o=ad the air shadow of the pharynx, larynx, and trachea.
Normally 10 mm at C1.
6 at C2
20 at C6
Increases with any ST mass (BPTA- blood, puss, tumor, adema)