Soft Tissue Signs- Cervical Spine

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Cervical spine imaging is one of the traditional mainstays of trauma radiography. The lateral cervical spine view is usually a routine view in patients with severe trauma (although increasingly displaced by CT imaging). The emphasis on 'clearing' the cervical spine in major trauma patients reflects the importance of not missing cervical spine injuries. This page considers soft tissue signs of cervical spine trauma.

normal retropharngeal soft tissues

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.

swallowing artifact

swallowing artifact 2
Assessment of the upper cervical prevertebral 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 prevertebral soft tissues are shown to be normal (arrows)

Pseudomass 2

swallowing artifact

This is an adult patient who was probably imaged mid-swallow. The prevertebral 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

cervical pseudo bone tumour 2

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).

This expiratory view shows that the inferior margins of the vocal cords almost form a right angle against a closed glottis. The subglottic trachea remains fully distended. (1)

The repeat image suggests that this is overlying air, probably in the pyriform fossa of the larynx.

Inspiratory view shows the vocal cords are open and the glottic airway is just a little narrower than the subglottic trachea (1)

Stylohyoid Ligament Calcification

stylohyoid ligament calcification

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


1. Susan D. John, MD and LeonardE. Swiscbuk, MD Stridor and Upper Airway Obstruction in Infants and Children.RadioGraphics, 643, July 1992

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