Distal cervical spine evaluation using swimmer's flexion-extension radiographs

Radiographic evaluation of the cervical spine begins with anteroposterior, lateral, and odontoid views. Unless the junction of C7-T1 can be adequately visualized on the cross-table lateral view, a swimmer's view is often performed. After fractures and subluxations have been excluded with these nonstressed views, spinal stability may be evaluated with stressed view radiographs such as a flexion-extension series. However, there is currently no protocol for evaluating the distal spinal stability in patients in whom traditional flexion-extension radiographs fail to visualize the important distal C7-T1 juncture. The present case study describes a trauma patient suffering from neck pain in whom cervical spine instability was ruled out using a swimmer's flexion-extension technique. Further study of this technique as a supplement to the conventional flexion and extension views in the stressed assessment of the entire cervical spine is recommended.