Cervical spine evaluation: efficacy of open-mouth odontoid view for nontraumatic radiography.

PURPOSE: The open-mouth odontoid view has been a standard component of radiographic cervical spine series regardless of setting or indication. This study examines the prevalence of disease in C-1 to C-2 in an outpatient setting for nontraumatic neck evaluations. MATERIALS AND METHODS: Reports of 1,033 nontraumatic cervical spine series on file at two large medical centers and at a large multispecialty clinic were reviewed retrospectively for patient characteristics, indications, and radiologic evaluations. RESULTS: The odontoid view in 10 patients demonstrated radiographic abnormalities in C-1 to C-2. Four of these patients had rheumatoid arthritis, two had metastatic carcinoma, one had Down syndrome, and the remaining three had no predisposing conditions for disease in C-1 to C-2. CONCLUSIONS: Odontoid view radiography is warranted in patients with conditions with increased risk for disease in C-1 to C-2, but for the vast majority of outpatients it is not worth the technical difficulty, radiation exposure, or expense.