Neck (Cervical Spine) X-ray (2 to 3 views)

What it is

The cervical spine is the stack of seven vertebrae between the skull and the shoulders, separated by cushioning discs. A two- or three-view series is the abbreviated version of the neck x-ray: typically a view from the side, which shows how the vertebrae line up in a curve and whether any one of them has shifted, and a view from the front. A third picture is sometimes taken with the mouth open, because that is the only angle from which the topmost vertebrae are not hidden behind the jaw. It is a study of bone and alignment. Discs, ligaments, and the spinal cord itself are invisible on it, which is why persistent nerve symptoms usually lead on to MRI.

Why it is done

• To check alignment and look for a fracture after a fall or a collision
• To look at wear in the joints and the height of the spaces between vertebrae in long-standing neck pain
• To check the position of screws, plates, or a fusion after neck surgery
• To rule out an obvious bony cause before ordering a more expensive study

What to expect

Metal comes off first — necklaces, earrings, hairpins, and anything in a collar. The patient usually stands facing an upright plate for one view and turns sideways for the next, with the shoulders dropped so they do not obscure the lower vertebrae. Each exposure takes a second and there is no sensation at all. If the neck is being imaged after an injury, the patient stays lying down in a collar and the films are taken around them without moving the neck, which takes longer and is less comfortable. Images are read by a radiologist, not by the technologist who took them.

Questions worth asking

• Does the order say two to three views or four to five? Adding views moves the study into a higher-priced code, and that decision is often made at the machine.
• If the first series is judged inadequate and repeated, is the repeat billed to me or absorbed by the department?
• Am I likely to need an MRI regardless? If so, it is worth asking whether the x-ray is a step toward it or a duplicate cost.
• Is this exam being done under a global emergency department charge, or will it arrive as its own line item weeks later?