Checklist

Address

• Name and date of birth

Adequate (views)

• Non-trauma: AP and lateral

• Trauma:

1. AP

2. lateral, C1 to C7/T1

3. peg view/open mouth

Alignment

• Lateral view:

• anterior longitudinal line

• posterior longitudinal line

• spinolaminar line

• spinous process (interspinous) line

• AP view:

• transverse spinous processes line up

• posterior spinous processes align themselves when seen ‘end on’

• Peg view:

• equal spaces on either side of C1 peg to C2 body

• lateral margins of C1–C2 align; if not aligned, suggestive of C1 blow-out (Jefferson) fracture

Bone

• Lateral view:

• all vertebral body heights must be the same

• anterior and posterior aspects of vertebral bodies should be concave

• AP view:

• spinous processes lie in straight line and are equidistant from each other

• the lateral edges of the vertebral bodies should all be equally aligned

• all vertebral bodies have two pedicles (owl eyes) – if not this suggests lytic destruction of pedicle (spinal tumour – usually metastatic)

• an increase in the interpedicular distance compared to the vertebral levels below is indicative of a burst type fracture

• Peg view:

• C2 vertebra odontoid process (peg) intact

• lateral margins of C1 and C2 align; failure of alignment suggests blow-out fracture of C1 (Jefferson's fracture)

Cartilage and ligaments

• Increased prevertebral soft tissue thickness is abnormal and can be a sign of a haematoma and occult fracture. Abnormal thickness is defined either in relation to the size of the adjacent vertebra or in millimetres.