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The atlas (C1) is the topmost vertebra, and along with the axis forms the joint connecting the skull and spine. It lacks a vertebral body, spinous process, and discs either superior or inferior to it. It is ring-like and consists of an anterior arch, posterior arch, and two lateral masses. The axis (C2) forms the pivot on which the atlas rotates.
X-ray consists of a three view cervical x-ray series, adding a swimmer's view if the lateral doesn't include the C7/T1 interface. CT scan should be thin slices, ideally 1.5 mm or less. [9] It should include first thoracic vertebra. [10]
Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views where care has been taken to expose for a true lateral view without any rotation offer the best diagnostic quality. Retrolistheses are found most prominently in the cervical spine and lumbar region but can also be seen in the thoracic area.
1. Cervical spine x-ray (lateral view) Once there is an onset of the symptoms in the patient, the patients are screened through cervical-spinal imaging techniques: X-ray, CT, MRI. The scanning technique points out any cervical vertebrae defects and misalignments. (Image 1. and 2.)
Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality. Retrolistheses are found most prominently in the cervical and lumbar region, but can also be seen in the thoracic area.
Thoracic Spine - AP and Lateral in the UK. [15] In the US, an AP and Lateral are basic projections. Obliques 20 degrees from lateral may be ordered to better visualize the zygapophysial joint. Lumbar Spine - AP and Lateral +/- L5/S1 view in the UK, with obliques and Flexion and Extension requests being rare. [15]
Those with neck pain only without any positive neurological findings usually do not require an x-ray of the cervical spine. For those with chronic neck pain, a cervical spine x-ray may be indicated. There are various ways of doing cervical spine X-rays such as anteroposterior (AP) view, lateral view, Swimmer's view, and oblique view.
The clivus is an important landmark for checking for anatomical atlanto-occipital alignment. When viewed on a lateral C-spine radiograph, the clivus forms a line which, if extended, is known as Wackenheim's clivus line. Wackenheim's clivus line should pass through the dens of the axis or be tangential to it. [9]