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Research ArticleCervical Spine

Enhancing Evaluation of Cervical Spine: Thresholds for Normal CT Relationships in the Subaxial Cervical Spine

Catherine W. Cahill, Kristen E. Radcliff and Charles A. Reitman
International Journal of Spine Surgery August 2018, 5062; DOI: https://doi.org/10.14444/5062
Catherine W. Cahill
1Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
MD
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Kristen E. Radcliff
2Thomas Jefferson University Department of Orthopedic Surgery, Egg Harbor, New Jersey
MD,
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Charles A. Reitman
3MUSC Department of Orthopaedics, Charleston, South Carolina
MD
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ABSTRACT

Background Very little normative computed tomography (CT) scan data exist defining expected relationships of vertebral structures in the intact cervical spine. Better understanding of normal relationships should improve sensitivity of injury detection, particularly for facet subluxation. The purpose of this paper was to describe the normal anatomical relationships and most sensitive measurements to detect abnormal alignment in the subaxial cervical spine.

Methods A group of 30 CT scans with no documented cervical spine injury were utilized from an established database in a trauma population. Twenty-two anatomical measurements were made for each level of the subaxial cervical spine using Microview software. For the purposes of measurement, the upper confidence limit of normal was reported as two standard deviations from the mean.

Results The novel, CT based measurements of bone articulation were generally smaller and had lower confidence intervals compared to traditional radiographic measurements of midline structures (such as interspinous distance, interlaminar widening, disc space widening). The upper limit of normal of facet joint height was reported (1.54 mm anterior, 1.27 mm posterior, and 2.0 mm midportion), which may help identify distractive-flexion injuries. The upper limit of normal vertebral translation (2.0 mm) was also reported to identify translation/rotation injuries.

Conclusions Normal CT measurements for the subaxial cervical spine, especially in the facets, were found to have small confidence limits and variation. Based upon these findings, we conclude that facet measurements and translation may be better screening tools than traditional radiographic criteria based upon midline structures. Using these measurements may improve detection of cervical spine injuries warranting further imaging or investigation and reducing missed injuries.

Clinical Relevance Improved understanding of normal anatomic measures in the subaxial spine will allow for better screening and identification of injuries.

  • cervical spine
  • intervertebral measurements
  • CT scan

Footnotes

  • Disclosures and COI: There was no funding source for this manuscript. This was approved by the Office of Research Institutional Review Board, Baylor College of Medicine.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery
Vol. 19, Issue 3
1 Jun 2025
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Enhancing Evaluation of Cervical Spine: Thresholds for Normal CT Relationships in the Subaxial Cervical Spine
Catherine W. Cahill, Kristen E. Radcliff, Charles A. Reitman
International Journal of Spine Surgery Aug 2018, 5062; DOI: 10.14444/5062

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Enhancing Evaluation of Cervical Spine: Thresholds for Normal CT Relationships in the Subaxial Cervical Spine
Catherine W. Cahill, Kristen E. Radcliff, Charles A. Reitman
International Journal of Spine Surgery Aug 2018, 5062; DOI: 10.14444/5062
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Keywords

  • cervical spine
  • intervertebral measurements
  • CT scan

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