III. Evaluation: General (Mnemonic: ABCDS)

  1. Adequate film and Alignment
  2. Bony landmarks
  3. Cartilaginous space and curvature
  4. Discs
  5. Soft tissue spaces

IV. Evaluation: Adequate film criteria

  1. Visualize all seven Vertebrae (including C7-T1)
    1. Major pitfall: Inadequate visualization of the entire Cervical Spine from C1 to the top of T1
    2. C7-T1 is a common site of Cervical Spine Injury (visualization is critical)
  2. Maneuvers to enhance view of lower C-Spine C7-T1
    1. Pull down on arms during cross-table lateral
    2. Swimmer's View
    3. Cervical Spine CT

V. Evaluation: Alignment

  1. Assessment criteria
    1. Landmarks should line up with <3mm discrepancy
  2. Landmarks
    1. Anterior Vertebrae
    2. Posterior Vertebrae
    3. Facets
    4. Spinous process (Spinolaminar line)
      1. Middle of anterior spinous process lines up C1-C3
  3. Normal variants: Pseudosubluxation of C2 and C3
    1. Normal in children
    2. Seen in 20% of children under age 8 years
  4. Abnormal findings
    1. Subluxation of >=3 mm is abnormal
    2. Angulation >11 degrees is unstable

VI. Evaluation: Bony landmarks

  1. Trace unbroken outline of each Vertebrae
  2. Trace odontoid outline from C2 Vertebrae

VII. Evaluation: Cartilaginous space

  1. Predental space (atlanto-dens interval)
    1. Distance from dens to C1 body
  2. Normal values
    1. Adult: 3mm
    2. Child: 5mm

VIII. Evaluation: Discs

  1. Assess symmetry of disc spaces
  2. Observe for avulsion Fractures off the Vertebral bodies
    1. Superior avulsion Fractures are stable
    2. Inferior avulsion Fractures are unstable

IX. Evaluation: Soft Tissue spaces

  1. Normal Fat tissue stripe <3 mm
  2. Maximum normal width of soft tissue stripe (Mnemonic: 6 at 2 and 22 at 6)
    1. Normal C2 stripe: 6-7 mm
    2. Normal C5-6 stripe: 22 mm (approximately Vertebral width)

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