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Cervical Spine Imaging in Acute Traumatic Injury
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Cervical Spine Imaging in Acute Traumatic Injury
, Acute Cervical Spine Imaging
See Also
NEXUS Criteria
Cervical Spine Injury
Pediatric Cervical Spine Injury
Cervical Spine CT
Cervical Spine XRay in Disc Herniation
Cross-Table Lateral C-Spine
film
Open Mouth Odontoid
view
Cervical Spine MRI
Indications
C-Spine Imaging in Acute
Traumatic Injury
Decision Rules
NEXUS Criteria
Canadian Cervical Spine Rule
Strong indications
Mental status less than alert or patient intoxicated
Focal neurologic deficit
Posterior midline neck tenderness
Patient reports
Neck Pain
(especially if out of proportion to physical findings)
Cancer (especially metastatic cancer)
Advanced
Arthritis
or
Degenerative Joint Disease
Severe
Osteoporosis
Upper extremity
Paresthesia
s
Other indications
Respiratory abnormality
Neck spasm (immediately following injury)
Paraspinous and trapezius
Muscle
spasm is expected following
Whiplash
and similar injuries
However spasm should not be present immediately after injury (e.g. initial ED evaluation)
Distracting injury (e.g. long bone extremity
Fracture
)
See NEXUS for distracting injury criteria (and for controversy)
Protocol
Imaging - Acute
Traumatic Injury
Precautions: Radiation risk
CT
Cervical Spine
is associated with significant radiation exposure (especially to
Thyroid Gland
)
CT
Cervical Spine
radiation dose at
Thyroid
averages 64 mSv in age <18 years
Contrast with
C-Spine XRay
: <1 mSv
CT
Cervical Spine
(contrast with 0.24-0.51% with
C-Spine XRay
) risk for
Thyroid Cancer
Thyroid Cancer
excess
Relative Risk
is 13% for males and 25% for females
Muchow (2012) J Trauma Acute Care Surg 72(2):403-9 [PubMed]
Cervical Spine XRay
Indications (inadequate in most cases where c-spine imaging is indicated)
Non-severe mechanism of injury (see
Cervical Spine CT
for indications) and
Adequate 3-view plain film
C-Spine XRay
s can be obtained and
Other CT imaging is not planned
Cervical Spine CT
Indications (first-line in most cases)
See
Cervical Spine CT
for indications and findings
Largely has replaced XRay in the U.S. for acute
Trauma
in adults
Most severe
Trauma
cases warrant
CT C-Spine
if other CT imaging is obtained
Examples:
CT Head
, chest/
Abdomen
/
Pelvis
MRI C-Spine
Indications
SCIWORA
suspected (neurologic deficits with normal imaging) or
Central Cord Syndrome
suspected or
Vascular neck injury suspected or
Obtunded patients (or otherwise unreliable exams) or
Pediatric patients (at some facilities if readily availability)
Weigh risk of CT (radiation) with risk of MRI (delays, need for sedation)
CT Neck Angiography
Blunt neck injury may result in occult and initially masked major neck vascular injury
Risk of
Carotid Artery Dissection
and thrombosis
May be initially asymptomatic with subsequent vessel thrombosis and hemispheric stroke within 72 hours
See
Neck Vascular Injury in Blunt Force Trauma
for CT Angiography criteria
References
Jang and Kaji (2013) Crit Dec Emerg Med 27(6): 2-9
Hoffman (2000) N Engl J Med 343:94-9 [PubMed]
Bagley (2006) Radiol Clin North Am 44(1): 1-12 [PubMed]
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