Cervical spine flexion patterns.

Area of Science:

• Radiology
• Orthopedics
• Emergency Medicine

Background:

• Cervical spine flexion and extension radiographs are crucial stress views for detecting unstable ligamentous injuries.
• Limited literature exists on the standardized evaluation of these dynamic radiographic views.
• Identifying normal and abnormal flexion patterns is essential for accurate diagnosis.

Purpose of the Study:

• To define distinct patterns of cervical spine flexion observed on stress radiographs.
• To correlate these flexion patterns with clinical findings and potential soft tissue injuries.
• To establish a baseline for interpreting dynamic cervical spine imaging.

Main Methods:

• Review of 150 consecutive lateral projection flexion and extension cervical spine radiographs from an Emergency Department setting.
• Classification of observed flexion patterns into distinct categories based on the number and location of flexion angles.
• Correlation of radiographic findings with available clinical data.

Main Results:

• Four distinct patterns of cervical spine flexion were identified.
• No flexion (24.7%) or a single flexion angle (24.7%) was associated with potential soft tissue injury.
• Two flexion angles (29.3%) represented a common, previously undescribed pattern indicating less than full flexion, seen in both normal individuals and those with mild injury.
• Three or more flexion angles (21.3%) were considered a normal pattern.

Conclusions:

• Attempted flexion with no or a single angle on stress radiographs may indicate ligament or muscle injury.
• The presence of two flexion angles at consecutive levels is a common finding, not indicative of significant injury.
• Multiple flexion angles generally represent normal physiological movement or mild, non-significant soft tissue limitations.