Cervical spine series

The cervical spine series is a set of radiographs taken to investigate the bony structures of the cervical spine, albeit commonly replaced by the CT, the cervical spine series is an essential trauma radiograph for all radiographers to understand.

Indications

Cervical spine radiographs are indicated for a variety of settings including ^1-3:

• trauma
• infection
• atypical pain
• limb pain
• osteoporosis
• degenerative changes

A decision to pursue C-spine imaging of any kind should be cross-referenced with the 'Canadian C-Spine Rule' for C-spine imaging due to its high sensitivity and specificity ⁴.

Projections

Standard projections

Note: in the absence of CT 5 views of the C-spine should be performed: AP, lateral, obliques and odontoid ⁵.

• AP  
  • anteroposterior projection of the cervical spine demonstrating the vertebral bodies and intervertebral spaces
• lateral  
  • often utilized in trauma demonstrated
    • zygapophyseal joints 
    • soft tissue structures around the c spine 
    • spinous processes 
    • anterior-posterior relationship of the vertebral bodies 
• odontoid  
  • also known as a 'peg' projection it demonstrates the  C1 (atlas) and C2 (axis)
• AP oblique
  • demonstrates the intervertebral foramina of the side positioned further from the image receptor
• PA oblique
  • demonstrated the intervertebral foramina of the side positioned closer to the image receptor

Additional projections

• cervicothoracic view (swimmer's view)
  • modified lateral projection of the cervical spine to visualize the C7/T1 junction
• flexion-extension lateral
  • specialized projections of the cervical spine often requested to assess for spinal stability.
• Fuchs view
  • non-angled AP radiograph of C1 and C2. It should not be used in a trauma setting