• Neck trauma (requiring operation for other injuries)
• Atlanto-axial subluxation = RA + Down syndrome

1. Demographic + technical aspects
2. Alignment
3. Bones
4. Soft tissues

Lateral cervical film

• adequacy
  • base of skull
  • 1st thoracic vertebra
  • sensitivity - 85%
    • with AP + open mouth (PEG) = 92%

CT C-spine

• inadequate plain film
• definite injury suspected

MRI C-spine

• evaluate cord compression

• symmetry on AP film
• 4 lines
  • anterior vertebral line
  • posterior vertebral line
  • spinolaminal line
  • spinous processes

• cervicocranium
  • C1 = anterior arch + posterior arch
  • C2 = odontoid peg + body
    • abuts C1 anterior arch
  • atlanto-dental space
• lower cervical vertebrae
  • vertebral body = fracture / compression
  • spinous process = fracture

• space narrowing

• abnormal thickening = soft tissue swelling