Soft Tissue Signs- Cervical Spine |

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Introduction

The cervical spine is one of the mainstays of trauma radiography. The lateral cervical spine view is usually a routine view in patients with severe trauma. The emphasis on clearing the cervical spine in major trauma patients reflects the importance of not missing cervical spine injuries. This page look at soft tissue signs of cervical spine trauma.

The retropharyngeal/preveretebral soft tissues can provide signs of cervical spine injury. This image demonstrates normal preveretebral soft tissues

Two assessments of prevertebral cervical spine soft tissues are commonly made.

C2 (black arrows)
The prevertebral soft tissues at C2 should measure less than 7mm or less than 50% of the width of the adjacent vertebral body

C6 (white arrows)
The prevertebral soft tissue sat C6 should measure less than 22mm . An alternative assessment is to compare the width of the adjacent cervical vertebral body. The prevertebral measurement should not be greater than the width of the vertebral body.

These criteria are guides only. Various studies have suggested alternative guidelines and any abnormal soft tissue findings should be interpreted in the context of bony appearances, mechanism of injury and clinical signs.

Pseudomass 1

The assessment of the prevertebral cervical soft tissues can be impossible if the patient (particularly paediatric patients) is swallowing at the time of exposure.


Assessment of the upper cervical prevertebrtal soft tissues is not possible in this image. The patient is likely to have been swallowing at the time of exposure	The view was repeated with the patient breathing through an open mouth. The upper prevertebal soft tissues are shown to be normal (arrows)

Pseudomass 2

This is an adult patient who was probably imaged mid-swallow. The brevertebral soft tissues associated with C1 and C2 appear abnormally wide. This appearance is associated with the patient swallowing rather than any cervical injury.

Radiographers use various techniques to avoid this appearance including exposing on inspiration and asking the patient to breathing through an open mouth at the time of exposure (try swallowing while breathing through an open mouth). Alternatively, asking the patient not to swallow at the time of exposure can be effective.

The Cervical Pseudo-bone Tumour


I was asked to repeat this AP cervical spine view by the referring doctor because of an apparent destructive bony process (arrowed).	The repeat image suggests that this is overlying air, probably in the pyriform fossa of the larynx

Stylohyoid Ligament Calcification

	The arrowed bony structure is calcification of the stylohyoid ligament. In florid cases this calcification can involve all of the stylohyoid ligament bilaterally. Extensive calcification of the stylohyoid ligament is associated with Eagle Syndrome.

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