Prevertebral soft tissue thickness is one of the important items to look in lateral radiographs of the cervical spine, as retropharyngeal infections can have a variable and non-specific presentation. In this case, the infection has a late presentation with osteomyelitis of the dens complicated by a pathological fracture. The odontoid process pathological changes were not seen on plain radiographs as it is masked by the atlas vertebra.

Erosion of the odontoid process can result from a number of pathological entities (see article).

Flexion and extension lateral radiographs are used to assess stability however patients experiencing pain are often unable to flex and extend the cervical spine and compensate with movement of the body which tilts the cervical spine and head as a unit.