Uncovertebral Osteophytes

3.34. Radiographs (8): Proximal (cranial) migration of the odontoid process is also commonly seen in rheumatoid arthritis. In the adult this may be assessed by noting lhe distance between the pedicle (P) of C2 (shown hatched) and a line connecting the spinous process (S) with the arch (A) of CI. If this is less than 11.5 mm. proximal migration is considered to be present.

3.35. Radiographs (9): Note the pharyngeal shadow, which normally lies fairly close to the bodies of the vertebrae as at (A). Displacement suggests a retropharyngeal mass, e.g. (B) suboccipital tuberculosis with abscess. Other causes include haematoma and tumour.

3.36. Radiographs (10): Where instability is suspected the lateral projection should be supervised with the neck (A) in extension, and (B) in flexion. Any latent instability should be discernible by comparing these views. If doubt remains, intensifier screening of movement may help.

Uncovertebral Arthritis NeckUncovertebral Arthritis Neck

3.37. Radiographs (11): Normal anteroposterior view of the lower cervical vertebrae.

3.38. Radiographs (12): In the anteroposterior view interpretation is difficult owing to the complexity of the superimposed structures. Note the shape of the vertebral bodies, observing (A) any lateral wedging, e.g. from fracture, tumour or infection. Note (B) the presence of any cervical rib.

3.39. Radiographs (13): Normal anteroposterior (through-the-mouth) view of

Atlanto Occipital Space

3.40. Radiographs (14): In the anteroposterior view of Cl-3, note (A) the atlanto-occipital joints, (B) the atlantoaxial joints, (C) the lateral mass of the atlas. Note any lack of symmetry in the alignment of the odontoid process with the atlas, and look for any evidence of fracture (E). Occasionally congenital abnormalities of the odontoid process (such as hypoplasia, or failure of fusion between its ossification centre and the main mass of the axis) may cause difficulties in interpretation.

Congenital Fused Cervical Vertebrae

3.41. Radiographs (15): Normal oblique projection of the cervical spine (one of two).

Uncovertebral Osteophytes

3.42. Radiographs (16): Right and left oblique projections are invaluable in demonstrating (A) localized lipping in the uncovertebral joints (joints of Luschka) which may be encroaching on the neural foramina (B). They may also show overlapping (locked) facet joints (C) in cervical subluxations.

Uncovertebral Osteophytes Pavlov Ratio

3.43. Radiographs (17): Suspected cervical myelopathy (I): (a) the Pavlov ratio. Normally, the depth (A) of the cervical canal, as seen in the lateral projection, is as great as that of its related vertebral body (B), giving a Pavlov ratio (A/B) of 1.0, and more than adequate room for the spinal cord. A Pavlov ratio of 0.8 or less indicates a developmentally narrow cervical canal, with risk of cord compression. If the ratio is reduced check the lumbar spine, as there may well be an associated lumbar spinal stenosis.

3.44. Radiographs (18): Suspected cervical myelopathy (2): If there are axial MRI scans (or postmyelographic CT scans) which show the cord at the suspect levels, the presence and degree of cord compression may be assessed by working out the cord compression ratio. This is calculated by dividing the (sagittal) diameter (thickness) (A) of the cord by its width (B). (As this is a ratio, the reduction effects of the scans are immaterial.) Note also that the cord may be considerably distorted, so use its minimal sagittal diameter for the calculation. A value of 0.4 is indicative of a serious degree of compression, and if decompression surgery is planned it is best done before a figure as low as this is reached.

3.45. Cervical spine radiographs: examples of pathology (1): The cervical curvature is reversed: there is wedging of the body of C6.

Diagnosis: fracture of C6.

Uncovertebral Osteophytes

3.46. Pathology (2): There is a vertical fissure in the body of C5, and less obviously, in C6. Diagnosis: fractures of C5 and C6.

3.47. Pathology (3): This oblique projection shows osteophytes arising from the uncovertebral joint.

Diagnosis: cervical spondylosis, associated in this case with unilateral compression of the C6 nerve root.

3.48. Pathology (4): The inferior articular process of C4 is displaced anteriorly over the upper articular process of C5. (The corresponding oblique projection of the other side is normal).

Diagnosis: unilateral facet joint dislocation, in this case with entrapment of C5.

Cervical Spine Slight DislocationCervical Spine Slight DislocationArticulaciones Uncovertebrales Luschka

3.50. Pathology (6): There is widespread fusion of the intervertebral facet joints, and the anterior longitudinal ligament is calcified. Diagnosis: ankylosing spondylitis.

3.49. Pathology (5): C3, 4 and 5 are represented by a solid bony mass. Diagnosis: congenital fusion of cervical spine.

3.50. Pathology (6): There is widespread fusion of the intervertebral facet joints, and the anterior longitudinal ligament is calcified. Diagnosis: ankylosing spondylitis.

3.51. Pathology (7): There is slight forward shift of the body of C6 relative to that of CI. Diagnosis: unilateral facet dislocation of C6 on C7.

3.52. Pathology (8): There is marked loss of vertebral alignment, and the inferior articular processes of C6 are lying in front of the superior articular processes of C7. The spinous processes of C5 and C6 are fractured. Diagnosis: dislocation of cervical spine (C6 on C7) with locked facets.

3.53. Pathology (9): There is narrowing of the C5-6 disc space and. to a lesser extent, that of C6-7. There is anterior lipping of C4. 5, 6, 7. There is posterior lipping of C5. Diagnosis: moderate degree of cervical spondylosis.

3.54. Pathology (10): There is gross anterior lipping of C5. 6 and 7. with near anterior interbody fusion. The pharyngeal shadow is distorted.

Diagnosis: severe cervical spondylosis, associated in this case with dysphagia. Similar appearances are found in Forestier's disease, a condition in which there is excessive, widespread osteophyte formation and abnormal ligamentous calcification (especially of the anterior longitudinal ligament).

Disc Osteophyte ComplexForestier Disease

3.55. Pathology (11): There is loss of the normal cervical curvature, narrowing of the C?-6 disc space and anterior lipping. There is an avulsion fracture of the anterior inferior margin of C4.

Diagnosis: extension injury of the spine with a marginal fracture and cervical muscle spasm in a patient susceptible to injury because of pre-existing cervical spondylosis.

3.56. Pathology (12): The radiograph has been taken in flexion (one part of a flexion and extension pair) and shows an excessive gap between the anterior arch of the atlas and the odontoid process. There is generalized vertebral demineralization. Diagnosis: rheumatoid arthritis with an atlantoaxial subluxation.

3.57. Pathology (13): There is deformity of the cervical spine, with the prescncc of only half of a vertebral body at the C6 level. Diagnosis: congenital deformity of the cervical spine (hemivertebra cervicalis).

Uncovertebral OsteophytesTransverse Process

3.58. Pathology (14): The transverse processes of the seventh cervical vertebra are enlarged on both sides. Diagnosis: congenital deformity of the cervical spine related to cervical rib.

3.59. Pathology (12): There is an extra rib on one side. Diagnosis: unilateral cervical rib.

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