When assessing cervical spine alignment, look for four parallel lines connecting structures in the cervical spine:
- anterior vertebral line: anterior margin of the vertebral bodies
- posterior vertebral line: posterior margin of the vertebral bodies (also known as George's line)
- spinolaminar line: posterior margin of the spinal canal
- posterior spinous line: tips of the spinous processes
These lines should follow a slightly lordotic curve, smooth and without step-offs. Any malalignment should be considered evidence of bony or ligamentous injury.