Table 4

Recommendation 9: Summary of included studies comparing imaging in the assessment of the cervical spine

Article year, (reference)No. of subjectsCervical spine imaging modalityParameter assessedOutcome
198910855CR (AP, lateral F/E, OM)Atlanto-axial lesions
Atlanto-occipital lesions
Odontoid lesions
Odontoid fibro-ostosis
Atlanto-axial lesions: CR = CT > MRI
Atlanto-occipital lesions: CR = CT > MRI
Odontoid lesions: MRI > CR/CT
Odontoid fibro-ostosis: CR = CT > MRI
known AAS
CR (F/E)AASMore detail seen with MRI, and using F/E views
200511031CR (F/E)ADI
Dense erosions
CR showed greater ADI in flexion than MRI, p 0.001
No significant difference in neutral/extension
Assessment of dens erosions easier with MRI
unstable AAS
CR (lateral N/F/E)AASSignificant difference between AAS in neutral and flexion/extension, p<0.0001
CR (AP, lateral N/F, OM)AAS
Odontoid erosions/cysts
Combination on MRI with CR showed more involvement than CT with CR (1.25-fold more VS; 1.13-fold more erosions/cysts)
200011342 symptomaticMRI (N/F)Reduction in subarachnoid spaceFlexion views showed more:
brainstem compression (1.17-fold)
reduction in the subarachnoid space at the atlanto-axial level (1.06-fold) and below C2 (1.13-fold)
Brainstem compression
200011425CR (AP, lateral F/E, OM)Odontoid erosionsLateral views showed more erosions (1.57-fold) than open mouth views
201111556 symptomaticCR (lateral)CT factors predictive of VS on CRVS greater in presence of odontoid erosions, p<0.05
Odontoid erosions significantly associated with odontoid osteoporosis, p<0.05
1995116136 symptomaticCR (AP, lateral F/E)MRI findings in normal CRAll MRI abnormal with normal CR:
Effusion: 28%
Pannus: 62%
200911740CR (lateralN/ F/E, OM)AAS
Dens erosions
% patients with C-spine involvement on:
CR 47.5%, MRI 70%, CT 28.2%
Anterior AAS seen more in flexion on CR than MRI, p<0.005
CT best at detecting lateral AAS
Dens erosions: CR 12.5%, MRI 67.5%, CT 41%
2011118267CR (lateral N/F/E)Baseline features predictive of VS and SAS at 5 yearsPrediction of VS: AAS, p 0.01; VS, p<0.01; SAS, p 0.06
Prediction of SAS: AAS, p 0.29; VS, p<0.01; SAS, p<0.01
198711918 symptomaticCR (AP, lateral F/E)AAS
Dens erosions
MRI vs CR:
AAS: 0.88-fold
CS: 1.0-fold
SAS: 0.5-fold
Dens erosions: 1.27-fold
200112046 symptomaticCR (lateral N/F, OM)Baseline CR and MRI features predictive of clinical neurological dysfunction at 1 yearCR not predictive (odontoid erosions, AAS)
Dysfunction according to MRI (OR):
Dens erosion: 1.5; atlas erosion: 4.9
Decreased subarachnoid space: 12.0
Decreased atlanto-axial space: 2.4
Brainstem compression: 2.3
  • AAS, atlantoaxial subluxation; ADI, atlanto-dental interval; AP, anteroposterior; CR, conventional radiography; CS, craniovertebral settling; E, extension; F, flexion; N, neutral; OM, open mouth; SAS, subaxial subluxations; VS, vertical subluxations.