Why 'look at the ceiling' and not tuck the chin for a C-spine?

A chin tuck flattens the natural cervical lordosis, which can narrow the canal on the images and create a pseudostenosis. A neutral, ceiling-facing position preserves the true curvature.

Why angle the axial slices per disc instead of one block?

The cervical spine is curved. A single perpendicular block cuts the discs obliquely at the top and bottom, which volume-averages a normal disc into looking herniated. Angling a small stack to each disc keeps every level true.

How do you stop swallowing from ruining a neck scan?

Place an anterior saturation band over the throat and instruct the patient to swallow only during the quiet gaps between sequences, never while the scanner is acquiring.

Resources/Protocols

Routine cervical spine

High-stakes imaging of the spinal cord. You are answering whether a disc is pressing on the cord, whether it is demyelination, or a tumour — and the lower neck is guarded by the shoulders and the swallow reflex.

Protocols/Spine

When this study is used

Neck pain, arm pain (radiculopathy) or signs of cord compression (myelopathy).
Trauma, suspected ligament or cord injury.
Suspected demyelination or intramedullary lesion.

Patient & coil positioning

Head-first supine in the head–spine array coil; nose to the ceiling, no chin tuck (tucking flattens the lordosis and fakes stenosis).
Depress the shoulders — 'reach your hands toward your feet' — and strap the arms, to clear artefact at the critical C6–T1 junction.
Place an anterior saturation band over the throat and coach the patient to swallow only in the quiet gaps between sequences.

Localizer

Three-plane localizer. The sagittal must show the medulla down to the T2–T3 disc — miss T1 and the exam is incomplete.

Sequence planning

Each sequence below lists how the slice group is positioned — the reference line it follows, its coverage, and why it earns its place in the protocol. Plan against the localizer, not by eye.

Sagittal T2

Sagittal

Planning — Aligned parallel to the cord on the coronal localizer, not the vertebral bodies (which may curve). Cover foramen to foramen.

Why — The 'myelogram effect' — bright CSF against dark cord and disc makes compression obvious.

Sagittal T1

Sagittal

Planning — Same alignment and coverage as the T2.

Why — Anatomical reference and marrow assessment.

Axial T2 (angled stacks)

Axial

Planning — Angle a separate small stack parallel to each disc space from C2–C3 to C7–T1 — never one straight block, which cuts a curved spine obliquely and fakes herniation. 3–4 slices per level, centred on the disc.

Why — Disc, canal and foraminal assessment at each level.

Sagittal STIR or T2 GRE

Sagittal

Planning — Match the sagittal coverage.

Why — STIR for cord oedema and ligament injury; GRE for blood products and demyelination.

Representative parameters

Ranges, not commandments — field strength, coil and vendor move the numbers. What must not move is understanding why each sits where it does.

Sequence	Field	Matrix / FOV	Notes
T2 TSE sagittal	1.5–3 T	320 / 24–28 cm	Myelogram effect
T1 TSE sagittal	1.5–3 T	320 / 24–28 cm	Anatomy, marrow
T2 axial	1.5–3 T	256–320 / 16–18 cm	Angled per disc
STIR sagittal	1.5–3 T	256 / 24–28 cm	Cord oedema, trauma

Artifacts & how to fix them

Artifact	Typical cause	Mitigation
CSF pulsation	Pulsatile flow inside the canal	Flow compensation; raise TE; gate if needed
Shoulder / wrap artefact	Dense tissue and aliasing at C7–T1	Superior sat bands; swap phase to right–left
Swallowing ghost	Oesophageal motion millimetres from the cord	Anterior sat band; scan during quiet breaks
Metal blooming (fusion)	ACDF plate/screws on GRE	Switch to TSE, wide bandwidth, STIR not fat-sat

What am I looking at?

You are not reporting the study, but recognising pathology helps you keep it in the field of view and know when to add a sequence or contrast. How the common findings read on the console:

Finding	Sequence to check	How it reads
Myelopathy	Sagittal T2	Cord pinched to an hourglass with a bright focus inside — flag it
Disc herniation	Axial T2	Disc margin convex ('frowning') or asymmetric rather than concave
Demyelination	Sagittal STIR/FLAIR	Bright focal spots within the cord substance

Review checklist

Sagittal covers the craniocervical junction and the C7–T1 disc.
Axial stacks angled per disc, each centred on its nucleus.
Cord–CSF contrast crisp; the cord reads grey with bright fluid both sides.
Shoulder and swallow artefact cleared from the lower levels.

Mistakes that cost repeats

A chin tuck flattening the lordosis into a pseudostenosis.
One straight axial block making a normal disc look herniated.
Missing T1 because the sagittal stopped short of the cervicothoracic junction.
Undepressed shoulders wiping out C6–T1.

Common questions

Why 'look at the ceiling' and not tuck the chin for a C-spine?: A chin tuck flattens the natural cervical lordosis, which can narrow the canal on the images and create a pseudostenosis. A neutral, ceiling-facing position preserves the true curvature.
Why angle the axial slices per disc instead of one block?: The cervical spine is curved. A single perpendicular block cuts the discs obliquely at the top and bottom, which volume-averages a normal disc into looking herniated. Angling a small stack to each disc keeps every level true.
How do you stop swallowing from ruining a neck scan?: Place an anterior saturation band over the throat and instruct the patient to swallow only during the quiet gaps between sequences, never while the scanner is acquiring.

Try it in ScanFlo: Plan the axial stacks two ways — angled to each disc, then as one straight block — and compare. The straight block bulges normal discs backward; the angled stacks show them true. That is the volume-averaging trap made visible.

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