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Roentgenographic Variations in the Normal Cervical Spine

Roentgenographic Variations in the Normal Cervical Spine Roentgenographic Variations in the Normal Cervical Spine 1 John H. Juhl , M.D. , Syney M. Miller , M.D. 2 and Gomer W. Roberts , M.D. University Hospitals 1300 University Ave. Madison 6, Wisc. ↵ 1 From the Department of Radiology, University of Wisconsin Medical Center, Madison, Wise. Presented in part as an exhibit at the Forty-sixth Annual Meeting of the Radiological Society of North America, Cincinnati, Ohio, Dec. 4–9, 1960. Excerpt The cervical spine with its relatively wide range of motion is peculiarly susceptible to indirect injury caused by sudden forces of acceleration or deceleration. This type of trauma, commonly termed whiplash injury, is a frequent result of automobile accidents. The mechanism of injury is sudden forcible flexion or extension of the neck, followed by less violent oscillations of flexion and extension. The human head is relatively large and heavy in proportion to the cervical spine and its supporting muscular and ligamentous structures. This undoubtedly contributes to the development of cervical injury (5). Many cases are complicated by the factor of potential compensation for personal injury and occur under circumstances which make it extremely difficult to evaluate the extent of disability. This fact has led to a number of studies of the roentgen changes in the cervical spine following trauma of the “whiplash” type. It is generally accepted that the normal cervical curve is convex anteriorly in the neutral position and that there is considerable variation in the degree of convexity. While there is some disagreement about the significance of a straight cervical spine, it is held almost unanimously that angulation, whether in the neutral position or in flexion, is abnormal and indicates a local weakness of supporting structures. The normal intervertebral disk spaces are rectangular in outline in the neutral position and become narrow anteriorly when the spine is flexed. In this position, there is also a very slight widening of the disk spaces posteriorly. This is caused by a rocking motion about an axis posterior to the vertebral body in the region of the pedicles. A second factor in flexion is a gliding motion of each vertebral body upon the one below it, resulting in slight forward displacement of one body upon another. Minor variations in the amount of displacement are not believed by most investigators to be abnormal. As a result of the rocking motion of one vertebra upon another, spinous processes are separated when the neck is flexed. This separation is not necessarily equal but is nearly so in the average normal subject. When the cervical spine is hyperextended, a reverse motion occurs, so that the bodies above tend to glide posteriorly upon those below. There are also some narrowing of the posterior aspect of the disk spaces and approximation of the spinous processes. In a cineroentgenographic study of the normal cervical spine, Fielding (4) found that the skull and first cervical vertebra move as a unit except in flexion and extension. There is a wide range of motion between the first and second cervical vertebrae. Below the second body lateral flexion and rotation are somewhat limited, while flexion and extension occur between individual elements. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Radiological Society of North America, Inc.

Roentgenographic Variations in the Normal Cervical Spine

Juhl, John H.; Miller, Syney M.; Roberts, Gomer W.
Radiology , Volume 78 (4): 591 – Apr 1, 1962
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Publisher
Radiological Society of North America, Inc.
Copyright
Copyright © 1962 by Radiological Society of North America
ISSN
1527-1315
eISSN
0033-8419
DOI
10.1148/78.4.591
Publisher site
See Article on Publisher Site

Abstract

Roentgenographic Variations in the Normal Cervical Spine 1 John H. Juhl , M.D. , Syney M. Miller , M.D. 2 and Gomer W. Roberts , M.D. University Hospitals 1300 University Ave. Madison 6, Wisc. ↵ 1 From the Department of Radiology, University of Wisconsin Medical Center, Madison, Wise. Presented in part as an exhibit at the Forty-sixth Annual Meeting of the Radiological Society of North America, Cincinnati, Ohio, Dec. 4–9, 1960. Excerpt The cervical spine with its relatively wide range of motion is peculiarly susceptible to indirect injury caused by sudden forces of acceleration or deceleration. This type of trauma, commonly termed whiplash injury, is a frequent result of automobile accidents. The mechanism of injury is sudden forcible flexion or extension of the neck, followed by less violent oscillations of flexion and extension. The human head is relatively large and heavy in proportion to the cervical spine and its supporting muscular and ligamentous structures. This undoubtedly contributes to the development of cervical injury (5). Many cases are complicated by the factor of potential compensation for personal injury and occur under circumstances which make it extremely difficult to evaluate the extent of disability. This fact has led to a number of studies of the roentgen changes in the cervical spine following trauma of the “whiplash” type. It is generally accepted that the normal cervical curve is convex anteriorly in the neutral position and that there is considerable variation in the degree of convexity. While there is some disagreement about the significance of a straight cervical spine, it is held almost unanimously that angulation, whether in the neutral position or in flexion, is abnormal and indicates a local weakness of supporting structures. The normal intervertebral disk spaces are rectangular in outline in the neutral position and become narrow anteriorly when the spine is flexed. In this position, there is also a very slight widening of the disk spaces posteriorly. This is caused by a rocking motion about an axis posterior to the vertebral body in the region of the pedicles. A second factor in flexion is a gliding motion of each vertebral body upon the one below it, resulting in slight forward displacement of one body upon another. Minor variations in the amount of displacement are not believed by most investigators to be abnormal. As a result of the rocking motion of one vertebra upon another, spinous processes are separated when the neck is flexed. This separation is not necessarily equal but is nearly so in the average normal subject. When the cervical spine is hyperextended, a reverse motion occurs, so that the bodies above tend to glide posteriorly upon those below. There are also some narrowing of the posterior aspect of the disk spaces and approximation of the spinous processes. In a cineroentgenographic study of the normal cervical spine, Fielding (4) found that the skull and first cervical vertebra move as a unit except in flexion and extension. There is a wide range of motion between the first and second cervical vertebrae. Below the second body lateral flexion and rotation are somewhat limited, while flexion and extension occur between individual elements.

Journal

Radiology – Radiological Society of North America, Inc.

Published: Apr 1, 1962

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