Exclusion of cervical spine instability in patients with blunt trauma with normal multidetector CT (MDCT) and radiography.

The objective of the study was to determine if negative multidetector computed tomography (MDCT) and lateral radiography of the cervical spine effectively excludes patients with unstable cervical spine injuries. Over a period of 40 months, 6558 people were admitted to our trauma service with blunt injury and 447 (6.8%) were found to have cervical fractures. Fractures were identified by CT and/or lateral radiography. In order to rule out clinically significant instability in the absence of fracture, we identified nine patients who required any type of stabilization of the cervical spine including anterior fusion, posterior fusion and external orthosis. These patients also underwent MR of the cervical spine. Radiography, CT, and MR images and reports of these nine patients were reviewed. Nine patients without a fracture required cervical stabilization. These patients had the following abnormalities: disc herniation with canal stenosis in three, unilateral jumped facet in three, and various other soft tissue abnormalities in three, all of which were evident on CT or radiography. All nine patients had evidence for cervical spine injury or instability by MDCT. Normal MDCT and radiography appears adequate to 'clear' the cervical spine. We recommend that patients requiring cervical spine clearance undergo a complete MDCT and lateral radiograph of the cervical spine. If these studies are entirely normal, then the cervical spine may be cleared. If any abnormalities, including disc herniation, soft tissue swelling and bony malalignments are noted by radiography and/or MDCT, further studies, including MR, are indicated prior to clearance of the cervical spine.

Imaging for evaluation of suspected cervical spine trauma: a 2-year analysis.

OBJECTIVE: To examine the role of radiography in screening trauma patients with suspected injury to the cervical spine. SUBJECTS AND METHODS: Over a period of 2 years, 5172 people were admitted to our trauma service and 297 (5.4%) were found to have cervical fractures. The radiographic and CT films and reports of 245 of these 297 patients were reviewed. RESULTS: The 245 subjects had sustained 309 distinct individual injuries. Radiography detected injuries in 108 cases (44.1%) and CT detected injuries in 243 cases (99.2%). The two fractures missed by CT occurred at C2; one fracture was obscured by dental artefacts and the other was in the horizontal plane of the scan. Both fractures were detected on lateral radiographs of the region. CONCLUSION: CT is superior to radiography for identification of cervical spine fractures. The fractures most likely to be missed by CT occur at C2. We recommend that CT be used as the primary screening method for people with suspected cervical injury, together with a single lateral view of the cervical spine to include the C2 region.

Helical CT of the cervical spine for trauma patients: a time study.

OBJECTIVE: The purpose of the study was to determine the time needed to perform a helical CT examination of the entire cervical spine. Our study population included 156 trauma victims: 100 of these patients underwent CT examination in conjunction with a cranial examination; the remaining 56 patients underwent a primary cervical examination only. CONCLUSION: Performing a cervical CT examination in conjunction with a cranial CT examination added an average of 12 min to the overall study time. The time for performing a primary cervical examination was 11 min on average. These times are approximately half of those required for a six-view radiographic evaluation. Helical CT has been suggested as a replacement for the more traditional radiographic evaluation of the cervical spine in trauma victims. Evidence now exists to support that recommendation.

Cervical radiography for trauma patients: a time-effective technique?

OBJECTIVE: The purpose of this study was to determine the time necessary to perform a six-view radiographic examination of the cervical vertebral column of trauma victims. In addition we compared the added examination times for 30 patients who underwent an additional helical CT examination of the cervical region immediately after cranial CT. CONCLUSION: Cervical radiography is a time-consuming procedure, which is a concern for trauma surgeons. A more efficient way for cervical evaluation of trauma patients needs to be adopted. Evidence now exists in the literature to suggest that helical CT can serve that purpose.