II. Efficacy: Blunt Trauma
- Inadequate for most Trauma patients (Cervical Spine CT is preferred)
- Adequate visualization of the entire Cervical Spine is achieved in <30% of plain film C-Spine XRays
- Misses up to 16% of C-Spine Fractures in seriously injured, obtunded blunt Trauma patients
- However, NEXUS found that adequate 3-view C-Spine XRays have >99% Test Sensitivity for significant Cervical Spine Injury
III. Indications: Acute Trauma
- Decision rules for Cervical Spine imaging in general
- Cases in which plain C-Spine XRay may be adequate in Trauma Evaluation
- Non-severe mechanism of injury (see Cervical Spine CT) and
- Adequate 3-view plain film C-Spine XRays can be obtained and
- Other CT imaging is not planned
IV. Imaging: Views -Primary
-
Cross-Table Lateral C-Spine film
- Test Sensitivity: 60-80% of Cervical Fractures
- Must be adequate prior to other views (including visualization of C7-T1)
- AP C-Spine
- Open Mouth Odontoid view
V. Imaging: Views- Other
- Flexion-Extension XRay (F/E Views)
- Contraindications to flexion extension views
- Suspected Cervical Fracture
- Subluxation
- Not recommended in Trauma Evaluation
- Most Cervical Spine injuries if visible on plain xray will be seen on other views
- Flexion-Extension Views add little additional diagnostic value
- Inadequate visualization in up to one third of patients
- Inadequate and inaccurate in obtunded patients with blunt Trauma
- May be unsafe with risk of Cervical Spine Injury if underlying unstable Fracture
- Results in prolonged C-Collar use without benefit
- Oh (2016) Emerg Med Australas 28(4): 450-5 +PMID:27255183 [PubMed]
- Abnormal findings
- Contraindications to flexion extension views
- Oblique C-Spine XRay (shows foramen)
- May be indicated inc chronic radicular symptoms
- Largely replaced by MRI Cervical Spine
VI. References
- Jang and Kaji (2013) Crit Dec Emerg Med 27(6): 2-9
- Bagley (2006) Radiol Clin North Am 44(1): 1-12 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Diagnostic Procedure (T060) |
| ICD10 | 58100-00 |
| SnomedCT | 145768001, 168574005, 66769009 |
| CPT | 72050, 72040 |
| Dutch | röntgenfoto van halswervel |
| French | Radiographie du rachis cervical |
| German | Roentgenaufnahme der Halswirbelsaeule |
| Italian | Radiografia della colonna cervicale |
| Portuguese | Raios X da coluna cervical |
| Spanish | Radiografía de columna cervical, radiografía de la columna cervical (procedimiento), radiografía de la columna cervical, rayos X de la columna cervical |
| Japanese | 頚椎Ｘ線, ｹｲﾂｲXｾﾝ |
| Czech | Rentgen krční páteře |
| English | C-spine x-ray, x-ray of cervical spine, x-ray of cervical spine (procedure), cervical spine x-ray, spine cervical x-ray, x-ray cervical spine, cervical spine radiography, cervical spine x rays, Radiography of cervical spine, Cervical spine X-ray (procedure), Cervical spine X-ray, X-ray of cervical spine, Radiography of cervical spine (procedure), Radiography of cervical spine, NOS, X-ray of cervical spine, NOS, X-ray of the cervical spine, X-ray;spine;cervical |
| Hungarian | Nyaki gerinc röntgen |
