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The Spine – Supplement (Online Only)


THE CERVICAL SPINE

FIGURE 3S-1, Apparent enlargement of the cervical spinal canal in a neonate as a result of flexion of the head at the time of filming and lordotic projection.

FIGURE 3S-2, Large cervical canal in a healthy 4½-year-old girl.

FIGURE 3S-3, Left, Simulated craniovertebral dislocation resulting from a slight tilting of the head at the time of filming. Right, Tomogram shows normal relationships of C1 to base of skull.

FIGURE 3S-4, Partial assimilation of the left lateral mass of C1 at the base of the skull. Note the asymmetry of the lateral masses of C1 that accompanies this variation.

FIGURE 3S-5, A second example of anomalous articulation between the posterior arch of C1 and the base of the skull.

FIGURE 3S-6, Complete absence of the posterior neural arch of C1.

FIGURE 3S-7, Incomplete formation of the neural arch of C1 with fragment seen in lateral projection (A) and in Towne's projection (B).

FIGURE 3S-8, Unilateral incomplete neural arch of C1.

FIGURE 3S-9, Failure of fusion of the posterior portion of the neural arch of C1 in an 8-year-old boy.

FIGURE 3S-10, Incomplete development of the neural arch of C1 simulating a fracture. Proven by CT scanning.

FIGURE 3S-11, Unilateral absence of a portion of the neural arch of C1. A, Defect seen in lateral projection. B, Defect seen in oblique projection. C, Normal side for comparison.

FIGURE 3S-12, The posterior arches of C1 (←) and C2 ( ) seen in the steep Towne's projection.

FIGURE 3S-13, Simulated fracture probably resulting from calcification of anterior spinal ligament. A, Plain film. B, CT scan.

FIGURE 3S-14, Fused ossicle above the anterior arch of C1.

FIGURE 3S-15, Huge ossicle fused to the anterior arch of C1.

FIGURE 3S-16, Probable calcification in the anterior longitudinal ligament below the anterior arch of C1.

FIGURE 3S-17, A, Plain Film. B, CT Scan. Hemangioma of the left lateral mass of C1 producing unusual osseous pattern. Proven by MRI.

FIGURE 3S-18, A, Plain Film. Shadow of the airway simulating a fracture of the lateral mass C1. B, Tomogram shows no fracture.

FIGURE 3S-19, A, B, Two examples of normal asymmetry of the lateral masses of C2.

FIGURE 3S-20, Accessory ossicle at the tip of the odontoid on CT scan.

FIGURE 3S-21, Persistence of a portion of the odontoid synchondrosis in a 13-year-old boy.

FIGURE 3S-22, “Double odontoid” produced by superimposition of the neural arch of C2.

FIGURE 3S-23, Failure of union of the odontoid process with a separate os odontoideum. Note also the failure of segmentation of C2. Os odontoideum is often difficult to differentiate from an old odontoid fracture. It is potentially dangerous if excessive motion is present.

FIGURE 3S-24, Huge os odontoideum. Note also the hypertrophy of the anterior arch of C1.

FIGURE 3S-25, Hypoplastic odontoid (←). There is a spina bifida occulta of C2 and C3 producing an apparent cleft in the odontoid process ( ).

FIGURE 3S-26, Asymmetric development of the lateral masses of C2 with lateral deviation of the odontoid process.

FIGURE 3S-27, A, B, Two examples of asymmetry of the lateral masses of C1 and C2.

FIGURE 3S-28, Unusual pointed anterior aspect of the odontoid process, not to be confused with the product of bony erosion (←). A, Plain film. B, Tomogram. Note also the spurlike extension from the superior aspect of the anterior arch of C1 ( ).

FIGURE 3S-29, Marked “waist” in the midodontoid process.

FIGURE 3S-30, Rotation of the head producing an unusual elongated appearance of the lateral mass of C2.

FIGURE 3S-31, Pseudofracture of the body of C2 produced by overlapping shadows of the teeth.

FIGURE 3S-32, Pseudofracture of the base of the odontoid process produced by the Mach effect from overlapping shadows of the posterior arch of C1, the tongue, or the occiput. This was proven a pseudofracture by tomography.

FIGURE 3S-33, Pseudofracture of the odontoid process produced by overlapping of the base of skull.

FIGURE 3S-34, A, Pseudofractures of the transverse processes of C1 and C2, produced by Mach bands, probably overlapping the shadow of the anterior tonsillar pillar. B, Tomography shows no evidence of a fracture.

FIGURE 3S-35, Osseous density representing the lateral mass of C2, thrown into relief by rotation and tilting of the head.

FIGURE 3S-36, Unfused anterior neural arch of C1 on CT scan.

FIGURE 3S-37, Persistent apophysis for the transverse process of C2.

FIGURE 3S-38, A, Simulated fracture or spondylolysis of C3 in infant as a result of positioning. B, Normal appearance seen on second exposure.

FIGURE 3S-39, Normal contour alterations in the neural arch of C2 can produce pseudofractures.

FIGURE 3S-40, Additional example of the groove of the neural arch of C2 that can be mistaken for a fracture.

FIGURE 3S-41, Spondylolysis of C2 in a 2-month-old child. Note that spondylolisthesis may occur with this entity and does not necessarily denote prior trauma.

FIGURE 3S-42, A, Facet between C1 and C2 seen as osseous mass as the result of rotation. B, Frontal view shows no abnormality.

FIGURE 3S-43, A, Simulated lesions between C1 and C2 and between C2 and C3 produced by rotation. B, Improved positioning eliminates the shadows.

FIGURE 3S-44, Left, Simulated fracture of the neural arch of C2, produced by rotation. Right, CT scan shows no fracture.

FIGURE 3S-45, A, Simulated fracture produced by Mach effect of the odontoid process (←). B, Tomogram shows no fracture of C1. Note the pseudofracture of C2 ( ).

FIGURE 3S-46, Asymmetric appearance of the pedicles of C2 related to a larger left vertebral artery that demonstrates a mildly anomalous course (←).

FIGURE 3S-47, Developmental cleft in the anterior aspect of C2.

FIGURE 3S-48, Failure of segmentation of the neural arches of C2 and C3.

FIGURE 3S-49, Partial nonsegmentation of C3 and C4.

FIGURE 3S-50, A, Posterior physiologic subluxation of C2 on extension view. B, Flexion view.

FIGURE 3S-51, Physiologic subluxation may occasionally be seen in cervical extension and in flexion, as in this 20-year-old man. A, Neutral position. B, Flexion. C, Extension.

FIGURE 3S-52, Normal cervical spine. A, Neutral position. B, Flexion. Note the striking alteration in curvature that can be produced with only slight alteration in head position.

FIGURE 3S-53, Physiologic subluxation of C2 on C3 and C3 on C4 on flexion in a 17-year-old boy.

FIGURE 3S-54, Physiologic subluxation of C2 on C3 and C3 on C4 in a 29-year-old pregnant woman, possibly related to relaxing hormone. A, Neutral position. B, Flexion.

FIGURE 3S-55, A, Simulated fracture of the posterior neural arch of C3 produced by rotation. B, Corrected position. No fracture is seen.

FIGURE 3S-56, A, Pseudofracture of the neural arch of the type shown in Figure 3S-55 (←). B, Repeat film shows disappearance of the pseudofracture shown in A .

FIGURE 3S-57, Accessory ossification centers at the tip of the spinous process of C3. A, Lateral projection. B, Oblique projection.

FIGURE 3S-58, Notochordal remnants at C2-C6.

FIGURE 3S-59, Two examples of the pseudovacuum of the cervical intervertebral disc related to the Mach effect phenomenon. This appearance should not be confused with the true vacuum sign of an intervertebral disc injury.

FIGURE 3S-60, Two examples of simulated fusion of the apophyseal joints produced by projection.

FIGURE 3S-61, Normal retention of wedge configuration of C3, C4, and C5 in an adult.

FIGURE 3S-62, Bifid spinous process of C4 with failure of union of the right limb.

FIGURE 3S-63, Unusual contour defect along the anterior margin of the vertebral end plate.

FIGURE 3S-64, A, B, Contour defects at C6 similar to those in Figure 3S-63 .

FIGURE 3S-65, Simulated destructive lesion of the third and fourth cervical vertebrae produced by slight rotation at the time of filming.

FIGURE 3S-66, Unfused uncinate apophysis, which might be mistaken for a fracture.

FIGURE 3S-67, Un-united ossification center of the inferior articular process of C5.

FIGURE 3S-68, Un-united ossification centers of the transverse processes of the last two cervical vertebrae in a 38-year-old man.

FIGURE 3S-69, A, Facet seen in the oblique projection and mistaken for a fracture of the pedicle. B, Tomogram shows no fracture.

FIGURE 3S-70, A facet resembling a fracture, seen in the oblique projection.

FIGURE 3S-71, A, Simulated fractures of the laminae of C5, produced by facets. B, Tomogram shows no fracture.

FIGURE 3S-72, Two examples of a simulated facet fracture at C5 produced by rotation of the spine at the time of filming.

FIGURE 3S-73, An anomalous articulation between the transverse processes of C5 and C6 can be seen with incomplete segmentation of these two vertebral bodies.

FIGURE 3S-74, Uptilted spinous process of C5 might be misconstrued as evidence of soft tissue injury between C5 and C6.

FIGURE 3S-75, Marked variability in the size of the cervical vertebrae.

FIGURE 3S-76, Sclerosis of the pedicles and posterolateral aspects of the vertebral bodies in a 36-year-old woman. This finding is apparently not related to degenerative spondylosis.

FIGURE 3S-77, Ossicle between C5 and C6, probably ligamentous.

FIGURE 3S-78, Calcification of the ligamentum nuchae at the base of the skull.

FIGURE 3S-79, Large transverse processes with attempts to form ribs at C5 and C7.

FIGURE 3S-80, Left, Long transverse process of C6, simulating a fracture. Right, Oblique projection shows the elongated transverse process.

FIGURE 3S-81, Left, Ringlike shadow produced by lateral elements of the vertebra with slight rotation at the time of filming. Right, True lateral projection does not show the ring shadow.

FIGURE 3S-82, Partial segmentation error at C4-C5. Note the underdevelopment of the vertebral bodies.

FIGURE 3S-83, Failure of segmentation of C5-C6.

FIGURE 3S-84, Posterior tilt of the spinolaminar line of C6, which should not be confused with the effect of an intraspinal lesion.

FIGURE 3S-85, Left, The laminar notch at C7, which was mistaken for a fracture. Right, Tomogram shows no fracture.

FIGURE 3S-86, Top left, The lateral elements of C6 projected slightly caudad show two apophyseal joints that were misinterpreted as fractures. Top right and bottom, Oblique projections show no abnormality.

FIGURE 3S-87, Left, Partial nonsegmentation of C6 and C7, which was mistaken for acquired narrowing of the intervertebral disc in a 35-year-old man. C2 and C3 are also nonsegmented. Right, The spina bifida occulta at C6 indicates the developmental nature of the finding at C6 and C7.

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