What X-ray views of the cervical spine are recommended for a patient with cervical spasm taking eperisone (eperisone) 50mg three times a day?

X-ray Views for Cervical Spine in Cervical Spasm

For a patient with cervical spasm, standard cervical spine radiographs are generally not indicated in the absence of "red flag" symptoms, as they rarely influence management or improve clinical outcomes in acute non-traumatic neck pain. 1

When Imaging Is NOT Needed

• Radiographs are often unnecessary in acute cervical spasm without red flags, as they do not change management or improve outcomes in simple muscle spasm cases 1
• The fact that the patient is already on eperisone (a muscle relaxant with vasodilatory properties) suggests this is being managed as a muscular/spastic condition rather than a traumatic or structural injury 2
• Eperisone works by inhibiting spinal reflexes and improving blood supply to skeletal muscles, making it appropriate for muscle contracture without requiring imaging confirmation 2, 3

If Imaging Is Clinically Indicated

When radiographs are deemed necessary (presence of red flags, trauma history, or failure to improve), the standard three-view cervical spine series should be obtained 1:

Standard Three-View Series Components:

• Cross-table lateral view - detects 60-80% of cervical injuries alone but misses approximately 15% 1, 4
• Anteroposterior (AP) view 1
• Open-mouth odontoid view 1

Critical Technical Requirements:

• Visualization must extend from the craniocervical junction (occipito-atlantal articulation) to the cervicothoracic junction (C7-T1) 1, 5
• If the cervicothoracic junction is not visible on the lateral view, a swimmer's lateral view should be added, as up to 60% of cervical injuries occur at this junction 1, 6
• Adequate penetration to visualize all vertebral bony structures and soft tissue relations is essential 1

Views That Should NOT Be Ordered

• Flexion-extension views are NOT useful in acute cervical spasm 1
  • Neck pain and muscle spasm limit spinal motion, preventing accurate assessment 1
  • These views rarely demonstrate instability not already identified on standard views 1
  • They are time-consuming and pose potential injury risk 1

Important Clinical Caveats

Red Flags Requiring Imaging:

• Trauma history 1
• Neurological deficits or radiculopathy 1
• Fever or signs of infection 5
• Age >50 with risk factors for fracture 6
• Failure to improve with conservative management 1

Limitations of Plain Radiographs:

• 10-20% of missed injuries result from misinterpretation of suboptimal radiographs 1, 5
• Plain films miss approximately 15% of cervical spine injuries even when technically adequate 1, 5
• CT detects 97-100% of fractures compared to only 60-80% for radiographs 4, 7

When to Escalate to Advanced Imaging

• MRI without contrast if neurological deficits are present or ligamentous injury is suspected 1, 5
• CT without contrast if radiographs show abnormal or ambiguous findings, or if high clinical suspicion persists despite normal radiographs 1, 5, 6
• CT is now considered superior to plain radiographs for initial trauma evaluation, with some centers eliminating lateral cervical spine X-rays entirely in favor of CT 7

Bottom Line for This Patient:

Given the clinical context of cervical spasm being treated with eperisone (a condition typically managed conservatively), imaging is likely unnecessary unless red flags are present. The medication regimen of eperisone 50mg three times daily is appropriate for muscle contracture and should provide relief within 3-10 days without requiring radiographic confirmation 2.