Neck (Cervical Spine) X-ray (6 or more views)

What it is

Seven small bones carry the head and let it turn in every direction, and the price of that mobility is that the neck can be unstable in ways the rest of the spine is not. A short X-ray series shows the stack from the front and the side. This longer one adds oblique angles, which turn the bony tunnels the nerve roots pass through into the plane of the film, and an open-mouth view, which is the only plain film that shows the top two vertebrae clearly. Series of this length often also include views taken with the neck bent forward and tipped back, which show whether the vertebrae stay properly lined up through movement or shift against each other.

Why it is done

• To evaluate the neck after an injury, looking for fracture and for misalignment
• To investigate lasting neck pain, or numbness, tingling or weakness running into an arm, where the openings the nerves exit through are what the oblique views show
• To assess arthritic change and narrowing between the vertebrae
• To check whether the alignment is stable when the neck moves, which a static view cannot show
• To look at the airway and soft tissue in front of the spine, which can widen when something is wrong behind it

What to expect

Necklaces, earrings, hairpins and removable dental work come off — anything metal near the neck will obscure the bones. You sit or stand against an upright plate for most views, and lie down for others. The technologist repositions your head between exposures: turned partway to one side, then the other, mouth held wide open for the view of the top two vertebrae, and for the motion views, chin tucked to the chest and then tilted back as far as is comfortable. Never force a movement that hurts — say so, and the view will be modified or skipped. Each exposure is brief; the full series usually runs fifteen to twenty minutes. After significant trauma, CT is often used instead, because it shows neck fractures more reliably.

Questions worth asking

• Was the full six-plus view series ordered, or would a shorter two or three view study answer the question at a lower price?
• Are the flexion and extension views billed within this code or added separately?
• If a CT of the neck is likely to follow anyway, is it worth doing these films first?
• If this is for an injury claim or a workers' compensation case, which payer should be billed directly?