information, and decreases the risk of missing a subtle injury An algorithm for considering radiographic evaluation is presented in Figure 112.15 An MRI should be considered to detect ligamentous, soft tissue, and/or spinal cord injuries Special consideration for MRI should be given to cases of nonaccidental trauma due to the increased risk of cervical spine ligamentous injuries and spinal subdural hematomas in this group compared to accidental injuries The next area of radiographic evaluation involves the cartilage Cartilage is radiolucent on plain radiographs The cartilaginous areas include the synchondroses or growth plates and intervertebral disc spaces ( Table 112.7 ) The growth plates may mimic fractures and may be confusing to those who are unaware of their presence Growth centers in the anterior-superior vertebral bodies cause a sloped appearance that may appear as a compression fracture to the untrained eye This anterior wedging on the radiographs can approach mm and still be considered normal Vertebral disc abnormalities may indicate specific types of injuries A vertebral disc space that is narrowed anteriorly may indicate disc extrusion, whereas a widened space suggests a hyperextension injury with posterior ligamentous disruption Soft tissue evaluation is extremely important Abnormal soft tissue spaces may be the only clue to the underlying ligament, cartilage, or subtle bone injury, which may not be obvious on the radiograph The soft tissue widening may represent blood or edema, which suggest an underlying injury The prevertebral space at C3 should be less than one-half to two-thirds of the AP width of the adjacent vertebral body ( Fig 112.19 ) This space will double to approximately the width of the adjacent vertebral body below C4 (the level of the glottis) because the usually non–air-filled esophagus is present at this area Care must be taken when evaluating the prevertebral soft tissue space because crying, neck flexion, or the expiratory phase of respiration may produce a pseudothickening in the prevertebral space ( Fig 112.20 ) Soft tissue abnormality should be reproducible on repeated radiographs if an actual underlying injury exists