Draw the following lines (visualize or mark the film).ĥ. Check for agenesis, fracture, or nonunion of the dens.Ĥ.

A measurement exceeding 3 mm in an adult or 5 mm in a child may indicate a damaged transverse ligament, a congenital anomaly, or an inflammatory process.ģ. Check the atlanto-dental interval (ADI) for enlargement. Check the posterior arch of atlas for fracture, nonunion, occipitalization, or basilar invaginationĢ. TABLE 4-1 Checklist for the Lateral Cervical Radiographġ.

This is a critical procedural step because the accuracy of this contact point is necessary in the successful delivery of an upper cervical Adjustment. This will also be used as a reference point to help locate the patient’s atlas transverse process. 3-2) will provide another landmark point on the lateral X-ray ( Fig. The lead shot that was taped to the anterior/inferior corner of the patient’s earlobe (see Chapter 3, Fig. The atlas transverse process should be outlined on the radiograph as well as the Mastoid process ( Fig. This will enable a more precise view of these anatomical structures to aid in the localization of the atlas transverse process. As an option, the doctor can tape a piece of lead shot over the tip of the Mastoid process to view its projection on the Lateral cervical view. It should be noted that due to magnification and the thickness of the connective tissue over the Mastoid process, the palpated location of the tip of the mastoid would not match its projection on the radiograph. The location of the atlas transverse process is also determined from the lateral cervical X-ray. Once again, these cases are extremely rare. Another option is to setup the X-ray tube so that the Central ray projects through the patient’s mouth as it is opened for the view. The nasium can be taken above an I1, although this could cause the atlas posterior arch to project a bit too high, depending on the patient’s true I-line. The doctor must choose between two options. Most of these cases will cause the teeth to superimpose over the atlas vertebra and prevent an accurate analysis. The doctor may be faced with a dilemma in the rare case of a patient presenting with an atlas Sagittal plane line that is lower than an I1. If this is the case, the S-line should be raised so that it will project over the teeth to avoid the atlas posterior arch attachment points from being obscured on the nasium X-ray. This is a common occurrence with young children, and wisdom teeth must be identified in adults. The lateral cervical film should be observed to determine if any teeth project along the pathway of the S-line. The doctor will conduct a more thorough pathological evaluation later when he/she has ample time before initiating care. An initial cursory evaluation of the film, from a pathological standpoint, should be conducted to screen for any unusual findings. The doctor should verify that the film does not have significant head tilt or rotation. The structure of the cervical spine should be adequately visualized, and all seven cervical vertebrae need to be present (except with rare patients). To determine the appropriate S-line for each case, the doctor must first determine if the X-ray was taken properly (see Chapter 3, Figs. However, the atlas presents in the superior plane in the vast majority of cases, so this line is generally referred to as an S-line. An atlas Sagittal plane line projecting through the hard palette is considered an S0. These Atlas plane lines are divided into two categories: lines projecting above the hard palette are S (or superior), and lines below the hard palette are I (or inferior). The lateral cervical film must be analyzed to determine the superiority or inferiority of the atlas in the Sagittal plane relative to the skull. The biomechanics and clinical significance of the lateral cervical curve will also be reviewed in this chapter. This information is essential for determining the contact point for delivering the Adjustment. The Lateral cervical view will also allow the doctor to find the atlas transverse process in its relationship to the Mastoid process and ramus of the mandible. These points are critical in the analysis of the nasium because they will be used to construct the Atlas plane line. This slope is necessary to project the image of the atlas posterior arch so that the inferior attachment points are clearly visible on the nasium X-ray. The lateral radiograph also provides information about the Sagittal plane of the atlas vertebra, which is measured so that this angle can be used to determine the Central ray for the nasium film. This chapter will provide a brief overview of the steps involved with assessing the osseous integrity of the cervical spine. The lateral cervical X-ray provides the doctor with potential pathological and biomechanical information that will aid in the care of the patient.

Abnormal cervical spine x ray