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The interpretation of diagnostic imaging results of the cervical spine and subsequent assimilation of that information with the clinical examination and other presentation data into decision making can be a challenge for even the experienced practitioner. Patients may present with a broad spectrum of pathologies, including potentially catastrophic injuries requiring considerable interpretive and reasoning prowess. Multiple imaging modalities may be employed to allow complete evaluation, including consideration for complex and occult injuries. Reasoning based on the patient history and possible clinical scenarios dictate the decision making as to the diagnostic test of first choice and perhaps subsequently. Key elements in initial decision making of cervical spine imaging include the presence or absence of trauma and the existence of any neurological signs or symptoms.

From a lateral view or in sagittal slices/reconstructions, subtle lordotic curves of the anterior and posterior margins of the vertebral bodies are to be present, forming references for expected alignment of the vertebrae and the integrity of the connecting tissues. The anterior and posterior spinal lines allow basic references for vertebral positioning. The junctions of the laminae and spinous processes, representing the posterior border of the central canal, define the spinolaminar line and a third curvilinear reference. The vertebral bodies are rectangular with smooth, curved margins. The disk spaces are consistent and reveal similar patterns of signal intensity on magnetic resonance imaging (MRI). The anterior aspects of spinous processes are in alignment, and the posterior tips of the spinous processes should be pointed in the same general direction.13

The tips of the spinous processes form a fourth curvilinear reference, albeit used less frequently. The zygapophysial (facet) joints are paired at each level with the joint margins congruent and their spaces evident. The distance between the odontoid process to the anterior and posterior arches of the atlas remains consistent whether the image is in neutral or in a position of flexion or extension, as in the case of dynamic images. On MRI, areas of atypical signal intensity warrant particular interest along with any suggestion of altered tissue integrity. The aforementioned relationships of vertebra and disks remain relatively uniform throughout the spine with no disruption of the gradual curve regardless of position in the sagittal plane25 (Figures 10-1 and 10-2).

Figure 10-1

A lateral view radiograph of the cervical spine in a 37-year-old woman.

Figure 10-2

A sagittal slice MR demonstrating a normal-appearing cervical spine.

Viewing the anatomy on anteroposterior (AP) or in coronal plane slices/reconstructions, the vertebral bodies are to be aligned in a relatively vertical column. The uncinate processes and, thus, the uncovertebral joints are clearly visible. The spinous processes are positioned in the midline. The facet joints, transverse processes, and pedicles are often difficult ...

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