Special projections may occasionally be required for sufficient evaluation of the structures of the cervical spine. 11.11) are not routinely obtained, although at times they help visualize obscure fractures of the neural arch and abnormalities of the neural foramina and apophyseal joints. Oblique projections of the cervical spine ( Fig. Visualized, particularly its upper half, then the Fuchs view may be helpful ( Fig. If the open-mouth view is difficult to obtain or the odontoid process is not clearly The body of C2 is clearly imaged, as are the atlantoaxial joints, the odontoid process, and the lateral spaces between the odontoid process and the articular pillars of C1. This view provides effective visualization of the structures of the first two cervical vertebrae. 11.9) may also be obtained as part of the standard examination. A variant of the anteroposterior projection known as the open-mouth view ( Fig. The spinous processes are seen almost on end, casting oval shadows resembling teardrops. 11.8), the bodies of the C3-7 vertebrae (and occasionally in young persons, even the C1 and C2 vertebrae) are well demonstrated, as are the uncovertebral (Luschka) joints and the intervertebral disk spaces. On the anteroposterior view of the cervical spine ( Fig. It is of the utmost importance on the lateral projection of the cervical spine that the C7 vertebra be visualized, because this is the most commonly overlooked site of injuries. The lateral radiograph may also be obtained in flexion of the neck, which is particularly effective in demonstrating suspected instability at C1-2 by allowing evaluation of the atlanto-odontoid distance an increase in this distance to more than 3 mm indicates atlantoaxial subluxation.

The bodies and spinous processes of C2-7 are fully visualized, and the intervertebral disk spaces and prevertebral soft tissues can be adequately evaluated. This projection suffices to demonstrate most traumatic conditions of the cervical spine, including injuries involving the anterior and posterior arches of C1 the odontoid process, which is seen in profile and the anterior atlantal-dens interval. The single most valuable projection in these instances is the lateral view, which may be obtained in the standard fashion or with the patient supine, depending on the condition ( Fig. Radiographic examination of a patient with cervical spine trauma may be difficult and is usually limited to one or two projections because frequently the patient is unconscious, there are associated injuries, and unnecessary movement risks damage to the cervical cord.

X ray of right lateral cervical spine