Cervical spine range of motion can provide valuable insights into dysfunction (e.g., limited right rotation and side-bending can indicate a right cervical facet dysfunction and rotation less than 45° can indicate dysfunction at C2). From: Concussion, 2020 Adam C. Crowl, James D. Kang, in
Clinical Sports Medicine, 2006 The cervical spine is composed of seven specialized vertebrae that provide a wide range of possible motions. Approximately 50% of
cervical flexion-extension and rotation occurs in the upper cervical spine (occiput-C2), with the remainder distributed among the subaxial segments. Ligamentous structures provide the main support to the cervical spine as there is little inherent bony stability. This is especially true in the upper cervical spine where the transverse ligament prevents atlantoaxial subluxation. The subaxial cervical spine relies on static stabilizers such as the anterior longitudinal ligament, intervertebral
disk, posterior longitudinal ligament, facet joint capsules, and interspinous and supraspinous ligaments to maintain stability while providing maximum flexibility. Important dynamic stabilizers include the sternocleidomastoid, paraspinal, strap, and trapezius muscles. These dynamic stabilizers are important in the acute evaluation as spasm in these muscles can mask ligamentous injury.7 Accordingly, rehabilitation and strengthening of these muscles can decrease the
risk of future injury. An assessment of both the osseous and ligamentous structures before determining the treatment plan is critical as unrecognized ligamentous injury can lead to late instability and neurologic compromise.8 Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B978032302588150018X CERVICAL SPINERONALD C. EVANS D.C., F.A.C.O., F.I.C.C., in Illustrated Orthopedic Physical Assessment (Third Edition), 2009 Next Steps/ProceduresBarré-Liéou sign, vertebrobasilar artery functional maneuver, Hautant test, DeKleyn test, Underburg test, vascular assessment, and vascular imaging (MRI) CLINICAL PEARL Cervical spine manipulation and adjunctive therapeutic techniques are safe to use. Nevertheless, the patient's welfare is always of prime concern, and screening tests will help identify patients who may be predisposed to cerebrovascular problems. During these procedures, symptoms of vertigo, nystagmus, dizziness, fainting, nausea, vomiting, visual blurring, headache (onset), or other sensory disturbances may identify a possible vertebrobasilar insufficiency. Problems in the cervical spine apart from the VAs may cause the same signs and symptoms. In suspected VA constriction, resisted neck extension may be painful, and prolonged cervical extension may produce a feeling of faintness. The transverse processes of the atlas are often tender on the side of involvement. These symptoms may improve significantly by using manipulative procedures. Therefore, manipulation should not necessarily be abandoned; rather, the manipulative technique should be modified so that simultaneous extension and rotation are not used. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323045322500080 CERVICAL SPINENigel Raby FRCR, ... Gerald de Lacey FRCR, in Accident & Emergency Radiology (Second Edition), 2005 INJURIES▪ 70% of detectable abnormalities will be visible on the lateral radiograph. Injuries are most common in the lower cervical spine (C5–C7) and at the C1–C2 articulation ▪The radiographs must be inspected systematically. The following step by step approach is recommended. STEP 1: ASSESS THE LATERAL VIEWFirst, check that the top of T1 vertebra is seenIf the top of T1 is not demonstrated, then the radiographer must obtain further views (Figs 8.13, 8.14). There are several options: a higher-penetration technique, bringing the shoulders down by pulling on the arms, a ‘swimmer's view’ or trauma obliques.8,9 Each of these additional views can be taken without moving the patient's head or neck. Secondly, trace the three contour lines or arcs (Fig. 8.15)If there is a step or kink in any of these lines, suspect a fracture or ligamentous disruption. Pitfall: The normal smooth cervical lordosis may be lost when the patient's neck is held in a hard or soft collar, or in spasm. Thirdly, check the vertebral bodies▪ Below C2 these should be of a similar size and contour ▪A detached fragment of bone may signify important ligamentous damage (Fig. 8.16) The spinous processes should be intact (Fig. 8.14). Fourthly, check the intervertebral disc spacesFollowing a very severe injury, a disc space may occasionally be widened when compared with the other normal spaces above and below.20 Finally, check the soft tissues
▪ Look for abnormal widening (Table 8.1), or a localised bulge (Fig. 8.17). Swelling of the prevertebral tissues occurs in approximately 50% of patients with a bone injury.21 If soft tissue swelling is present then all the views need to be scrutinised again for other subtle evidence of a bone or ligamentous injury. STEP 2: ASSESS THE LONG AP VIEWFirst, check that the spinous processes are in a straight line▪ If they are not in line – a unilateral facet joint dislocation must be excluded (Figs 8.18, 8.19) ▪Whenever deviation of a spinous process is detected, the lateral view needs very careful reassessment. Note: the spinous process of a vertebra as seen on the AP view is usually projected over the body of the vertebra at least one segment lower. Secondly, check that the distances between the tips of adjacent spinous processes are roughly equal▪ Abnormal widening of an interspinous distance (i.e. a space more than 50% wider than the space immediately above or below; Figs 8.20, 8.21) is diagnostic of an anterior cervical dislocation.15 This observation is most useful in the severely injured patient whose shoulders have obscured some of the vertebrae on the lateral view20 ▪Abnormal widening (page 160) provides an important warning that the neck must be managed very carefully whilst an adequate lateral view is obtained. Pitfall: If the neck is held in flexion, abnormal widening may be due to projection only. Nevertheless, in the context of trauma, whenever this 50% rule is broken an injury should be assumed and an expert opinion obtained. STEP 3: ASSESS THE C1–C2 ARTICULATIONOn the lateral radiographLook for: ▪A fracture of the odontoid peg (Fig. 8.17) ▪Horizontal disruption (Fig. 8.22) of the Harris' ring of C2 vertebra ▪Widening of the distance (Fig. 8.23) between the anterior margin of the peg and the posterior aspect of the arch of C1. It should be no more than 3 mm in an adult ▪A fracture of the posterior arch of C1 or the lamina of C2 (Fig. 8.24) ▪Displacement of the posterior arch of C1 from its expected alignment as part of the smooth curve of line 3 (Fig. 8.23) ▪Prevertebral soft tissue swelling (Fig. 8.17). On the AP peg viewLook for: ▪Fracture through the odontoid peg ▪Displacement of the margin of either of the lateral masses of C1 away from the corresponding margin of C2 (Fig. 8.25) ▪Unequal or increased spacing between the peg and the lateral masses of C2 (Figs 8.12, 8.25) FOUR IMPORTANT PITFALLSMach effect▪ It is common to see a thin black line (Fig. 8.26) across the base of the peg that does not represent a fracture. The optical illusion results from overlapping shadows from superimposed structures. It is known as a Mach band or Mach effect.22 It is important to be aware of these lines. It is even more important to seek advice before too readily dismissing any line as an artefact. Developmental variants▪ A vertebra might appear slightly narrow anteriorly with loss of the normal square or rectangular outline (Fig. 8.27). This can mimic a compression fracture. Although this narrowing is sometimes due to old trauma or aging it is often due to persistence of the normal, slightly wedge shape that is present during adolescence23 ▪A small calcified opacity anterior to a vertebral body (Fig. 8.27) can be mistaken for a fracture fragment. Sometimes this represents a detached osteophyte from a previous injury. Alternatively, it might be a remnant of an ununited secondary ossification centre.23 When such an opacity is detected, an experienced observer should review the radiographs. Cervical spondylosis▪ Degenerative changes are common over the age of 40. Distinguishing between changes due to spondylosis and those resulting from an acute injury is not always easy. The following are frequently present in the middle-aged and elderly □The anterior margin of a vertebral body shows a step on the vertebra below (Fig. 8.28). This is due to an osteophyte. It may be misinterpreted as indicating vertebral subluxation □Anterior subluxation (Fig. 8.29) secondary to facet joint osteoarthritis. There is no simple way of distinguishing this from traumatic subluxation on the plain radiographs Fortunately, correlation of the clinical symptoms and signs with the site of the radiographic abnormality will provide reassurance in most instances. In other cases an injury should be assumed until an experienced observer has reviewed the radiographs.24 Delayed instability▪ Severe pain and spasm may make it difficult to exclude a significant injury to the posterior ligament complex. Muscle spasm can hold the neck in an anatomical position and mask ligamentous rupture. Instability may only become evident after a few days when the spasm has resolved. For this reason it is important that any patient who has severe pain and spasm but appears fit for discharge is put in a collar and asked to re-attend within a few days for lateral views in flexion and extension. These radiographs must be taken under close clinical supervision. If the additional plain film findings remain equivocal, it will usually be necessary to refer the patient for MRI to exclude a ligamentous injury. KEY POINTS ▪The majority of injuries are shown on the lateral radiograph ▪The following need to be checked: On the lateral view □top of T1 visible □three smooth arcs maintained □vertebral bodies of uniform height □odontoid peg intact and closely applied to C1 □no localised bulge in the prevertebral soft tissues On the long AP view □spinous processes in a straight line and spaced equally On the open mouth AP peg view □peg intact □equal spaces on either side of the peg □lateral margins of C1 and C2 align ▪Be cautious. An important neck injury may still be present despite normal plain films. Clinical history and examination must always take precedence over apparently normal radiographs. THE SUBTLE SIGN NOT TO MISS
Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780702026676500129 Cervical spineWhitney Lowe BA LMT NCTMB, in Orthopedic Massage, 2003 DescriptionIntervertebral discs in the cervical region are exposed to compressive forces primarily from the weight of the head. However, in other situations the load on the cervical spine may be increased, if an individual falls or hits the ground or some other object with the top of the head. A common example where this occurs is someone diving into a shallow pool and hitting his/her head on the bottom of the pool. While the normal compressive load on the cervical spine is nowhere near that of the lumbar spine, there may still be enough of a compressive load to adversely affect the spinal structures. Since the cervical vertebrae in the spine are significantly smaller than their lumbar counterparts, it takes a smaller load on them to create compressive distress. An accumulation of compressive forces on the cervical spine may cause degeneration of the intervertebral disc. Stenosis (narrowing) of the intervertebral foramen will often accompany these degenerative changes. In many instances, the stenosis will increase the likelihood of neurological symptoms as nerve roots get compressed by the narrowing space around them. Muscle weakness and sensory symptoms including paralysis in the upper extremity have been identified in patients with spinal stenosis (Pavlov et al 1987). Herniation technically means a pushing through. The primary problem occurs because degeneration of the annulus fibrosus allows the nucleus to push through it (Fig. 9.8). As the nucleus continues to press into the annulus, it will cause the annulus to change shape. Eventually, if not halted, the nucleus may push all the way through the annulus. Degeneration of the annulus may be the result of numerous factors, including poor disc nutrition, loss of viable cells, loss of water content and others (Buckwalter 1995). Most of these problems originate from excessive compressive loads on the spinal structures over time. These factors may cause the intervertebral disc to lose some of its thickness prior to actually herniating. When a disc has lost some of its thickness it is common for an individual to be given a diagnosis of degenerative disc disease. Essentially, this means for some reason the disc has lost thickness and the vertebrae in the region are closer together. However, this does not necessarily mean that pathological symptoms will follow. Degenerative disease of the spine is likely to occur in the absence of clinical symptoms. Therefore, the presence of a degenerative disc condition is not any guarantee that there is a pathology directly related to it (Boden et al 1990). There are several different names given to the different degrees of disc herniation. While these names are not always consistent in the literature, they do give a greater degree of specificity as to how bad the disc herniation is (Magee 1997). Figure 9.9 illustrates the different degrees of disc herniation. In a disc protrusion (also called a bulge), the disc has changed shape, but the majority of the annulus fibrosis is still intact. This disc is considered prolapsed if only the outer-most fibers of the annulus are still containing the nucleus. In an extrusion, the disc material has pushed through the outer border of the annulus, but it is still connected to itself. The final stage of degeneration is sequestration. In this stage the disc material has actually separated from itself, and portions of the disc material may be freely floating in the spinal canal. The process of herniation of the nucleus pulposus in the cervical region is similar to that which occurs in the lumbar region. However, there are several reasons why discs in the cervical region are not as vulnerable to disc herniations as those in the lumbar region. The posterior longitudinal ligament (Fig. 10.1) protects protrusions in the cervical region better than it does in the lumbar region, because it is wider in the cervical region. In the cervical region it covers the majority of the posterior aspect of the disc. In addition, the nucleus is situated farther anteriorly in the cervical region, making the possibility of a posterior protrusion less likely (Cailliet 1991). In the cervical region disc herniations are most likely to affect the nerve roots that make up the brachial plexus. Symptoms from compression of these nerve roots are going to be felt down the length of the upper extremity. However, nerve roots are not the only tissues that may be affected by the herniating nucleus pulposus. Pain may also come from the disc pressing on the posterior longitudinal ligament, dura mater, or spinal cord (Cailliet 1991). It has recently been suggested that some cervical pain associated with disc herniations may be coming from the disc itself, because the discs appear to have nerve fibers and mechanoreceptors in them (Mendel et al 1992). Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780723432265500150 Specific disordersSara Haspeslagh, ... Maarten Van Kleef, in Interventional Spine, 2008 CERVICAL ZYGOAPOPHYSEAL PAINClinical syndromePatients with cervical zygapophyseal (facet) joint pain present commonly with a dull and aching bilateral neck pain. Pain emanating from the cervical facet joints can refer into the occiput, interscapular, or shoulder girdle regions dependent on the cervical facet joint involved in the patient's pain syndrome.1–4 Pain from the higher cervical facet joints may end up causing cervicogenic headache.5 On physical examination one may find a reduced range of motion of the cervical spine if the higher facet joints are involved. Marked paravertebral tenderness to palpation suggests regional soft tissue changes in response to the underlying injured facet joint, but these findings are not pathognomonic. X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) scans may reveal morphological abnormalities; however, there is no direct relationship between anatomical findings and pain.6–8 Indications and contraindicationsThe indications to perform a radiofrequency (RF) denervation of the medial branches that innervate the cervical facet joints are identical for nontraumatic and post-traumatic neck pain. In whiplash-associated cervical pain the periosteal tearing of the facet joints due to muscle ligamentous sprain is thought to be the most common cause of neck pain.9–11 Atraumatic cervical pain can be due to progressive degenerative facet disease (for example, joint arthritis) or postural changes. Cervicogenic headache (CH) is another possible indication of performing an RF denervation of the medial branches of the cervical facet joints. It is typically described as a unilateral headache localized in the neck or occipital region and sometimes projecting to the forehead. The referred pain originates from the cervical structures, which in some instances is singularly from the facet joints. This distinct headache syndrome was described as early as 1926. Sjaastad et al. were the first to name it CH and to propose diagnostic criteria.5,12 RF denervation of the cervical medial branches tend to reduce nociceptive output from structures such as spinal facet joints and spinal nerve roots, so this intervention has been proposed to be an effective treatment of CH.13 The contraindications of facet joint denervation are systemic infection, local infection in the overlying soft tissue, and coagulation disorders. Other contraindications include are an allergy to the injected medication and refusal of the patient to undergo the procedure. Side effects and complicationsA common side effect (in 13% of the patients) of the RF denervation of cervical facet joints is a transient increase in pain in the neck that resolves in 2–6 weeks.14 Vervest and Stolker also reported 4% of patients with occipital hypesthesia, which resolves in 3 months. They suggest this side effect is caused by a lesion of the third occipital nerve. Another side effect that is described after RF denervation of the third occipital nerve is a transient ataxia and unsteadiness, probably secondary to a partial blockade of the upper cervical proprioceptive afferents.3 Since the vertebral artery and the cervical segmental nerves lie just anteriorly to the cervical facet joints, there is the possibility of making contact with them if the needle is entered too anteriorly. Since the epidural space lies immediately medially to the facet joint, a deviation of the needle toward the midline should be avoided because of the risk of penetration into the epidural space or subarachnoid space. OutcomesIn 1980, Sluijter and Koetsveld-Baart15 concluded that RF lesioning of the cervical facet joints and/or dorsal root ganglion can be of considerable help in a selected group of patients. This judgment was based on observing 61% of patients obtaining in excess of 40% symptom relief following RF, while obtaining no benefit from prior treatments. In an open prospective study in 1995, Lord et al. evaluated the pain relief in the upper and lower cervical region using RF lesions of the medial branch of the posterior primary ramus (RF-PFD) in 19 patients using a posterior approach.16 Patient selection was based on comparative local anesthetic blocks. The procedure was effective in the lower region in 7 of 10 (70%) patients but only in 4 of 9 (44%) patients in the higher region, i.e. the C2–3 facet joint. That study concluded that the encouraging results of RF lesions at the medial branch of the dorsal ramus at the lower cervical levels justified a randomized, double-blind, controlled trial. One year later, Lord et al. performed a randomized, double-blind, controlled trial in patients with chronic pain of the lower cervical facet joints after whiplash injury.11 This study revealed that, in patients with chronic facet joint pain, confirmed with double-blind, placebo-controlled local anesthetic blocks, percutaneous RF neurotomy with multiple lesions of target nerves could provide lasting pain relief and was not a placebo effect. In 1999, McDonald et al.17 published a double-blinded, controlled study to determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in the treatment of chronic neck pain. They only performed the neurotomy (using the posterior parasagittal approach) in patients with a positive response to either comparative or placebo-controlled blocks. Their conclusion was that the relief of neck pain obtained by percutaneous radiofrequency neurotomy can be clinically satisfying, but of limited duration. They also stated that the effects of these procedure could be reinstated if pain recurs. The prospective study of Sapir and Gorup, published in 2001,18 compared the efficacy of radiofrequency medial branch neurotomy to treat cervical zygapophyseal joint pain in patients with whiplash who were either litigants or nonlitigants. They found no difference in outcomes following radiofrequency treatment in patients with the potential of secondary gain. They also concluded that radiofrequency neurotomy is efficacious for the treatment of traumatic cervical facet arthropathy. Geurts et al. concluded that there is limited evidence for RF facet denervation in the treatment of chronic cervical pain following a whiplash event.19 Radiofrequency lesioning of the cervical facet joints in the treatment for neck pain and headache was performed in several studies.20,21 These studies suggest that RF can offer a tangible benefit, but that the results are modest and not compelling. In a recent open prospective study, Van Suijlekom et al. evaluated the effect of headache relief in patients with cervicogenic headache after RF-PDF at the levels C3–6.13 In that study the lateral approach was used. They demonstrated that RF cervical facet denervation leads to a significant reduction in headache severity, number of days with headache, and analgesic intake in patients with cervicogenic headache diagnosed according to the criteria of Sjaastad et al.5 In 2004 Stovner et al. published a randomized, double-blind, sham-controlled study to determine whether RF denervation of facet joints C2–3 could be a good treatment of cervicogenic headache.22 They could include only 12 patients in total and did a follow-up of 24 months. They found some improvement in the neurotomy group at 3 months, but later on there were no marked differences between the RF group and the sham group. Their conclusion was that the procedure is probably not beneficial in cervicogenic headache. At this juncture, in the authors' view, a definite conclusion about the clinical efficacy of the procedure can only be made following a randomized, controlled trial including a large number of patients. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780721628721500716 Rheumatoid Arthritis and Related DisordersHarlan C. Amstutz, Michel J. Le Duff, in Hip Resurfacing, 2008 Involvement of the Cervical SpineCervical spine involvement in a patient with RA is common, and it must be evaluated in all patients requiring a general anesthetic given by endotracheal intubation. Standard roentgenograms of the cervical spine should be obtained, as should an open-mouth frontal projection and a lateral view in flexion and extension, assessing the stability of the cervical spine. Subluxation of 6 to 7 mm mandates a careful neurologic examination. This subluxation is variable and must be dealt with on an individual basis. Additional studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) scans, are also helpful for evaluating these patients. Some RA patients and most JRA patients have a stiff cervical spine, and some will have limited jaw motion as well. Such patients may require nasotracheal intubation. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9781416047247500210 Related Referral Joint TestingTodd S. Ellenbecker MS, PT, SCS, OCS, CSCS, in Clinical Examination of the Shoulder, 2004 CERVICAL SPINE CLEARING TESTSThe cervical spine can be the source of pain in patients presenting with primary complaints of shoulder and arm pain and disability. Use of the overpressure and Spurling's tests provide valuable insight into the condition of the cervical spine and its related structures (Grimsby & Gray, 1997). Cervical spine overpressure tests are completed after the patient has moved the cervical spine via the cardinal movements of flexion, extension, lateral flexion, and rotation. In the event that active range of motion of the aforementioned movements is within normal limits and does not elicit or reproduce symptoms, passive overpressure is applied at the end of each range of motion. Although the presence of any symptom with these movements and overpressures is important, the reproduction of the patient's symptoms in the shoulder or scapular region is of particular concern because this will ultimately lead the clinician to suspect that the patient's symptoms arise from the cervical spine. Isometrically applied resistance in mid-ranges of cervical spine motion can be applied to stress the contractile elements, with end-range overpressure exerted to stress the noncontractile elements (Davies et al, 1981). Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780721698076500072 Cervical Coronal Plane DeformitiesHarminder Singh, ... James S. Harrop, in Benzel's Spine Surgery, 2-Volume Set (Fourth Edition), 2017 Cervical Spine DysmorphismsCervical spine dysmorphisms (CSDs) occur in a heterogeneous group of patients unified by the presence of congenital defects that result from malalignment, formation, or segmentation of the cervical spine, thus generating disability. This problem requires comprehensive evaluation of patients with a diagnosis of scoliosis, correlating clinical and radiologic findings and the presence of numerous abnormalities of other systems to give an appropriate syndrome diagnosis and multidisciplinary management of these patients with the aim to give them an integral rehabilitation treatment increasing their quality of life. Santillan Chapa and colleagues described clinical and radiologic findings in children with diagnosed CSD. They studied 47 consecutive outpatients of the Pediatric Rehabilitation Division in Instituto Nacional de Rehabilitacion with diagnosed scoliosis. Sixteen patients (34%) had diagnosed CSD. The most frequently seen syndromes were Klippel-Feil (19%), Wildervanck (4.3%), neurofibromatosis (4.3%), Morquio (2.1%), Stickler (2.1%), and Williams (2.1%). The researchers found CSD in 34% of the group studied, greater than in the medical literature.73 Morquio syndrome, or mucopolysaccharidosis IVA, is a genetic deficiency of N-acetylgalactosamine-6-sulfate sulfatase that results in an accumulation of lysosomal mucopolysaccharides. This accumulation occasionally manifests as cervical scoliosis among a varied presentation of skeletal dysplasias.74 Stickler syndrome is an autosomal dominant connective tissue disorder marked by ocular involvement. Obvious skeletal and facial deformities are present. Cervical dysmorphism is highly likely by adulthood.75 Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323400305001489 Functional anatomy of the bony cervical spineSteven D. Waldman MD, JD, in Physical Diagnosis of Pain (Fourth Edition), 2021 The mobility of the cervical spineThe cervical spine has the greatest range of motion of the entire spinal column and allows movement in all planes. Its greatest movement occurs from the atlanto-occipital joint to the third cervical vertebra. Movement of the cervical spine occurs as a synchronized effort of the entire cervical spine and its associated musculature, with the upper two cervical segments providing the greatest contribution to rotation, flexion, extension, and lateral bending. During flexion of the cervical spine, the spinal canal is lengthened, the intervertebral foramina become larger, and the anterior portion of the intervertebral disc becomes compressed (Fig. 1.3B). During extension of the cervical spine, the spinal canal becomes shortened, the intervertebral foramina become smaller, and the posterior portion of the anterior disc becomes compressed (Fig. 1.3C). With lateral bending or rotation, the contralateral intervertebral foramina become larger, while the ipsilateral intervertebral foramina become smaller. In health, none of these changes in size results in functional disability or pain; however, in disease, these movements may result in nerve impingement with its attendant pain and functional disability. Read full chapter URL: https://www.sciencedirect.com/science/article/pii/B9780323712606000101 Which of the following is are demonstrated in a lateral projection of the cervical spine?Spine Question's. What limits cervical lateral flexion?Uncovertebral joints (Joints of Luschka):
They allow for flexion and extension and limit lateral flexion in the cervical spine. They prevent posterior linear translation movements of the vertebral bodies,Important in providing stability and guiding the motion of the cervical spine.
Which factor is most important to open the intervertebral joint spaces for a lateral thoracic spine projection?Positioning of the Cervical and Thoracic Spine. What anatomical structures of the cervical spine are best demonstrated by the lateral projection?XR 105 Midterm. |
Which of the following factors does not apply to a lateral projection of the cervical spine
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