Disclosures
- updated 16 Jul 2023:
Nothing to disclose
Updates to Article Attributes
The Rule of Spence is a radiologic method to evaluate the likelihood of injury to the transverse atlantal ligament (TAL) on an open mouth AP (“peg”) radiograph. As originally framed, if the combined projection of the lateral masses of the atlas is more than 6.9 mm beyond the lateral masses of the axis, an injury to transverse ligament is likely. However the original rule was derived from cadaveric studies, and not on radiographs. Work;It has since then hasbeen shown that using a threshold of >8.1 mm is more accurate once radiographic magnification error is accounted for 3.
Studies suggest that the Dickman addition to the Gehweiler classification of C1 fractures is of greater clinical utility than the Rule of Spence. The Rule being, which is somewhat inaccurate at excluding transverse ligament injury (TLI) or providing clinical prognostication 2.
-<p>The <strong>Rule of Spence</strong> is a radiologic method to evaluate the likelihood of injury to the <a href="/articles/cruciate-ligament-of-the-atlas">transverse atlantal ligament (TAL)</a> on an <a href="/articles/cervical-spine-fuchs-view">open mouth AP (“peg”) radiograph</a>. As originally framed, if the combined projection of the <a href="/articles/atlas-c1">lateral masses of the atlas</a> is more than 6.9 mm beyond the <a href="/articles/axis-c2">lateral masses of the axis</a>, an injury to transverse ligament is likely. However the original rule was derived from cadaveric studies, and not on radiographs. Work since then has shown that using a threshold of >8.1 mm is more accurate once radiographic magnification error is accounted for <sup>3</sup>.</p><p>Studies suggest that the Dickman addition to the <a href="/articles/gehweiler-classification-of-atlas-fractures">Gehweiler classification </a>of C1 fractures is of greater clinical utility than the Rule of Spence. The Rule being somewhat inaccurate at excluding transverse ligament injury (TLI) or providing clinical prognostication <sup>2</sup>.</p>- +<p>The <strong>Rule of Spence</strong> is a radiologic method to evaluate the likelihood of injury to the <a href="/articles/cruciate-ligament-of-the-atlas">transverse atlantal ligament (TAL)</a> on an <a href="/articles/cervical-spine-fuchs-view">open mouth AP (“peg”) radiograph</a>. As originally framed, if the combined projection of the <a href="/articles/atlas-c1">lateral masses of the atlas</a> is more than 6.9 mm beyond the <a href="/articles/axis-c2">lateral masses of the axis</a>, an injury to transverse ligament is likely. However the original rule was derived from cadaveric studies, and not on radiographs. It has since been shown that using a threshold of >8.1 mm is more accurate once radiographic magnification error is accounted for <sup>3</sup>.</p><p>Studies suggest that the Dickman addition to the <a href="/articles/gehweiler-classification-of-atlas-fractures">Gehweiler classification </a>of C1 fractures is of greater clinical utility than the Rule of Spence, which is somewhat inaccurate at excluding transverse ligament injury (TLI) or providing clinical prognostication <sup>2</sup>.</p>
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