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A 42-year-old man was the front seat passenger in a car that was struck on the driver’s side by another vehicle. Neither car was going at high speed. Damage to the patient’s car was limited to the front fender; the windshield was not “spidered.” The patient was wearing a seat belt at the time of the collision. He was brought to the ED in full spine immobilization and was triaged to one of the examination rooms.

The patient was awake and alert with no overt signs of trauma. His vital signs were normal. He complained of pain in his neck, lower back, and right wrist. He noted that he had struck his head on the car door and had been “dazed” for a few seconds, but was uncertain whether he had lost consciousness.

On examination, he had mild midline neck tenderness without deformity. There were good bilateral breath sounds without chest wall tenderness. His abdomen, pelvis, and extremities showed no signs of injury. The neurological examination was normal.

The patient was removed from the “long board” and sent for cervical spine radiography. The radiographs are shown in Figure 1.

  • Are there any abnormalities?

Although ABCS (alignment, bone, cartilage, and soft tissues) is a convenient mnemonic device for the interpretation of the lateral cervical spine radiograph, one element seen on the lateral view is not emphasized in this scheme–alignment of the articular facets and lateral masses of C3–C7.

Each vertebra has two lateral masses and each lateral mass has a superior and inferior articular facet. On the lateral view, each lateral mass has a diamond shape formed by the superior and inferior articular facets and the anterior and posterior cortical surfaces. In a perfectly positioned lateral view, the left and right lateral masses are exactly superimposed. More often, the patient’s positioning is slightly rotated and the lateral masses are not exactly superimposed (Figure 2).

Figure 2

Effect of rotation of a lower cervical vertebra as seen on the lateral radiograph.

(A) Correct alignment (no rotation): the left and right lateral masses are perfectly superimposed on the lateral view.

(B) Rotational malalignment: the left and right lateral masses are not superimposed.

[From Gerlock AJ, Kirchner, SG, Heller RM, Kaye JJ: The Cervical Spine in Trauma, Advanced Exercises in Diagnostic Radiology, Vol. 7, Saunders, 1978, with permission.]

In this patient’s lateral view (Figure 1), the positioning is slightly rotated and the articular facets do not exactly overlap. However, at C3 there is an ...

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