If the clinician’s request asks for a lateral projection with flexion and extension then perform the following procedures.Be careful to ensure that the patient does not elevate the shoulders. As a final step before exposure, ask the patient to relax and drop the shoulders down and forward as far as possible.Ask the patient to elevate the chin slightly (to prevent superimposition of the upper cervical spine by the mandible).Adjust the shoulders to lie in the same horizontal plane and be sure the patient’s body is in a true lateral position with the long axis of the cervical vertebrae parallel to the plane of the cassette.Center the mid-coronal plane (the plane that passes through the mastoid tips) to the midline of the cassette.For non-trauma cases, position the patient in a lateral position, either seated or standing, with the patient's shoulder against a vertical cassette holder.Positioning for a lateral projection of the cervical spine Minimum SID of 60 inches-72 inches (150-180 cm).Image receptor (IR): 8 x 10 inch (18 x 24 cm).It is of the utmost importance on the lateral projection of the cervical spine that the C-7 vertebra be visualized, as this is the most commonly overlooked site of injury. The lateral view can also be obtained in flexion and extension of the neck, which is particularly effective in demonstrating suspected instability at C-1 to C-2 by allowing evaluation of the atlanto-odontoid distance. The bodies and spinous processes of C-2 to C-7 are fully visualized, and the intervertebral disk spaces and prevertebral soft tissues can be adequately evaluated. This projection suffices to demonstrate most traumatic conditions of the cervical spine, including injuries involving the anterior and posterior arches of C-l the odontoid process, which is seen in profile and the anterior atlantal-dens interval. The single most valuable projection in these instances is the lateral view, which may be obtained in the standard fashion or with the patient supine, depending on their condition.

Frequently the patient is unconscious, there are associated injuries, and unnecessary movement risks damage to the cervical cord.

Radiographic examination of a patient with cervical spine trauma may be difficult and is usually limited to one or two projections.

Cervical spine ap x ray