Orthopedics Book


C-Spine CT

Aka: C-Spine CT, CT C-Spine, Cervical Spine Computed Tomography, Cervical Spine CT
  1. See Also
    1. Cervical Spine Trauma
    2. Cervical Spine Imaging in Acute Traumatic Injury
    3. NEXUS Criteria
    4. Canadian Cervical Spine Rule
    5. Cervical Spine XRay
    6. Cervical Spine MRI
  2. Indications: Acute Trauma
    1. Decision rules for Cervical Spine imaging in general
      1. See Cervical Spine Imaging in Acute Traumatic Injury
      2. See NEXUS Criteria
      3. See Canadian Cervical Spine Rule
    2. Absolute indications for CT C-Spine over Cervical Spine XRay (C-Spine Injury probability >5%)
      1. High risk mechanism of injury
        1. High-speed MVA with combined impact >35 mph (or 56 kph)
        2. MVA with death at scene
        3. Fall from height >10 feet (or 3 meters)
      2. High risk clinical findings
        1. Significant Closed Head Injury or Intracranial Hemorrhage on Head imaging
        2. Neurologic symptoms or signs referred from the Cervical Spine
        3. Multiple extremity Fractures
        4. Pelvic Fracture
      3. References
        1. Hanson (2000) AJR Am J Roentgenol 174(3): 713-7 [PubMed]
    3. Other indications for CT C-Spine over XRay
      1. In most Trauma cases Cervical Spine imaging is performed with CT
        1. Alternatives such as Cervical Spine XRay is often inadequate with up to 20-40% False Negative Rate
      2. C7 difficult visualization (e.g. obese or muscular patients)
      3. Abnormal cervical anatomy such as Rheumatoid Arthritis or Osteoarthritis in elderly (especially C1 and C2 injuries)
  3. Adverse Effects
    1. See CT-associated Radiation Exposure
    2. Concentrated radiation to skin of neck and Thyroid Gland
  4. Efficacy: Acute Traumatic Injury
    1. Test Sensitivity for Fracture: 98%
    2. CT Cervical Spine alone with axial slices <3mm has 100% NPV for unstable Cervical Spine Injury
      1. May someday obviate need for C-Collar or MRI in obtunded patients (follow local guidelines)
      2. Patel (2015) J Trauma Acute Care Surg 78(2): 430-41 [PubMed]
  5. References
    1. Jang and Kaji (2013) Crit Dec Emerg Med 27(6): 2-9
    2. Bagley (2006) Radiol Clin North Am 44(1): 1-12 [PubMed]
    3. Holmes (2005) J Trauma 58(5): 902-5 [PubMed]
    4. Bailitz (2009) J Trauma 66(6): 1605-9 [PubMed]

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