The cervical spine region is one of the most common areas of dysfunction treated by clinicians. Conditions resulting from acute trauma, degenerative disorders, and chronic postural strains can cause pain and debilitation that lead the patient to seek therapeutic or surgical intervention. Important to the clinical evaluation in any of these patient groups is an understanding of the underlying degenerative changes of the spine revealed on radiographs. The degree of severity of degeneration will affect the ability of the spine to withstand trauma, assume postural changes, and make functional gains in mobility and movement patterns.
In radiology, the cervical spine is one of the most frequently evaluated body segments. A busy emergency department frequently evaluates the cervical spine for direct trauma and also screens for indirect trauma if the patient has been in a severe fall or accident. The mobility of the cervical spine allows for protection of the neural contents but at the same time predisposes it to certain types of injury. If some trauma has occurred, the injury potential of this vulnerable area of the body should never be underestimated, even if the trauma is at a site in the body far from the neck. Clinicians should review the radiologist's consultation prior to initiating the evaluation of a patient who has suffered a cervical spine injury. Equally important, the clinician should never rely on the results of any diagnostic study alone. Physical evaluations, including ligamentous stability tests, are also important and should be performed on every patient who has sustained a cervical spine trauma. The determination of treatment is based on all components of the examination—the history, clinical evaluation, and laboratory tests as well as the radiologic findings.
The cervical spine (Fig. 7-1) consists of seven vertebrae positioned in a lordotic curve. The atlas (C1) (Fig. 7-2) and axis (C2) (Fig. 7-3) have unique characteristics. The remaining vertebrae, C3 (Fig. 7-4) through C7, share common osseous features.
Divisions of the spinal column.
Typical cervical vertebra.
The atlas, so named for the mythical earth-supporting giant, supports the globe of the head. The atlas is composed of anterior and posterior arches united by lateral masses and forming a bony ring. Long, perforated transverse processes extend from the lateral masses and are easily palpated behind the angles of the mandible. The anterior arch has a midline anterior tubercle on its outer surface ...