Imaging of the Cervical Spine > Interpretation > The Odontoid View

The Odontoid View

First, assess if the film is Adequate.
An adequate film should include the entire odontoid and the lateral borders of C1-C2.

Then, examine the Alignment.
Occipital condyles should line up with the lateral masses and superior articular facet of C1.

The distance from the dens to the lateral masses of C1 should be equal bilaterally (see figure below). Any asymmetry is suggestive of a fracture of C1 or C2 or rotational abnormality. It may also be caused by tilting of the head, so if the vertebrae is shifted in on one side, then it should be shifted out on the other side.

The tips of lateral mass of C1 should line up with the lateral margins of the superior articular facet of C2. If not, a fracture of C1 should be suspected.

Finally, examine the Bony Margins.
the Odontoid should have uninterrupted cortical margins blending with the body of C2.

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