Make note of the normal lines that should be intact on this view ( Fig. A patient in a hard cervical collar also has a straightened curvature. When the patient has pain, straightening of the spine may occur secondary to muscle spasm. This can lead to serious consequences! On the lateral radiograph the normal cervical curve should be mildly convex anteriorly (lordotic). It is not uncommon to stop looking once one abnormality is found. If it does, put that aside and force yourself to look at the entire study. Glance at the entire image to see if something obvious jumps out at you. 9.1A) as it is the most important cervical spine radiograph. You will eventually develop your own system, but the following one will work until you do ( Table 9.3). Normal versus abnormal as well as detection of subtle changes may have profound effects on patient outcome.Īs previously emphasized in other anatomic regions, a systematic approach for evaluating the spine is needed. In addition, some patients may not be able to have an MRI because the strong magnetic field may disrupt a pacemaker, displace an aneurysm clip, or the patient may not tolerate the relatively confined space.ĭespite a decreasing need for radiography of the spine, a thorough understanding is necessary, particularly since post injury follow-up examinations are typically radiographs. However, MRI costs at least twice as much as CT imaging. MRI is also used when a spine fracture is present and an associated cord injury is suspected ( Table 9.2). MRI is very good for imaging soft tissues and the bone marrow, spinal cord, and the intervertebral discs.ĬT is, however, quite helpful for localizing the exact position of vertebral fracture fragments following acute trauma, particularly important when the fracture fragments are displaced into the spinal canal. CT can demonstrate disc disease and degenerative facet disease, but has largely been replaced by MRI for this purpose. CT delineates anatomy and pathology, particularly lateral disc herniations, more clearly than does myelography with only radiography. Magnetic resonance imaging (MRI) can be a useful, noninvasive diagnostic tool in visualizing the spine, discs, and nerves, and its use is increasing while utilization of the invasive myelogram with CT is decreasing.

Yet according to the American College of Radiology Appropriateness Criteria, imaging is usually not appropriate for uncomplicated acute low back pain and/or radiculopathy with a nonsurgical presentation. These images may be supplemented with oblique and coned-down views to better visualize an area, and occasionally lateral flexion and extension views are requested to document spine motion and stability. Following a thorough history and physical examination, anteroposterior (AP) and lateral radiographs often are the first radiologic consultation to be requested to evaluate the symptomatic region of the spine. When patients do seek medical care for back pain, radiologic imaging is frequently overutilized. Occupational-related back injuries are not uncommon and other common etiologies of back pain are listed in Table 9.1. Most people recover from their back pain with little or no medical care. The pelvis articulates with the sacrum on each side, supports many soft tissue structures, articulates with the femurs, and is the proximal attachment for many muscles involved in locomotion.īack pain is a problem for the majority of patients at some time in their lives. The spine consists of cervical, thoracic, lumbar, and sacral divisions composed of bones, joints, ligaments, muscular attachments, and nerves. It is the main structural support for the body and, as a result, is subjected to many stresses. The axial skeleton consists of the skull (which is covered separately), the spine, and the pelvis. Ankylosing Spondylitis, Psoriasis, and Reiter Syndrome (Reactive Arthritis)

Cervical spine x ray normal