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How to differentiate between subluxation and pseudosubluxation of C spine?

Asked by Napoli 

In children younger than 8 years, the C2-C3 space or occasionally C3-C4 space can have a normal physiological displacement in lateral flexion and extension views radiographs of cervical spine. It can occur in upto 40%.

To distinguish pseudosubluxation from traumatic subluxation: 

1. Draw a posterior cervical line between the spino-laminar lines of C1 and C3. 

2. This line should pass through or be less than 2mm anterior to the C2 spino-laminar line to be considered physiological. 

3. If the distance is >/= 2 mm, the subluxation must be considered traumatic. 

4. Pseudosubluxation is exaggerated with the neck flexed and reduced with neck extension.

Swischuk's line