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Cervical Spine XRay

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Cervical Spine XRay, C-Spine XRay, Cervical Spine XRay in Acute Traumatic Injury

  1. Inadequate for most Trauma patients (Cervical Spine CT is preferred)
  2. Adequate visualization of the entire Cervical Spine is achieved in <30% of plain film C-Spine XRays
  3. Misses up to 16% of C-Spine Fractures in seriously injured, obtunded blunt Trauma patients
  4. However, NEXUS found that adequate 3-view C-Spine XRays have >99% Test Sensitivity for significant Cervical Spine Injury
  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. Cases in which plain C-Spine XRay may be adequate in Trauma Evaluation
    1. Non-severe mechanism of injury (see Cervical Spine CT) and
    2. Adequate 3-view plain film C-Spine XRays can be obtained and
    3. Other CT imaging is not planned
  • Imaging
  • Views -Primary
  1. Cross-Table Lateral C-Spine film
    1. Test Sensitivity: 60-80% of Cervical Fractures
    2. Must be adequate prior to other views (including visualization of C7-T1)
  2. AP C-Spine
  3. Open Mouth Odontoid view
  • Imaging
  • Views- Other
  1. Flexion-Extension XRay (F/E Views)
    1. Contraindications to flexion extension views
      1. Suspected Cervical Fracture
      2. Subluxation
    2. Not recommended in Trauma Evaluation
      1. Most Cervical Spine injuries if visible on plain xray will be seen on other views
      2. Flexion-Extension Views add little additional diagnostic value
      3. Inadequate visualization in up to one third of patients
      4. Inadequate and inaccurate in obtunded patients with blunt Trauma
      5. May be unsafe with risk of Cervical Spine Injury if underlying unstable Fracture
      6. Results in prolonged C-Collar use without benefit
      7. Oh (2016) Emerg Med Australas 28(4): 450-5 +PMID:27255183 [PubMed]
    3. Abnormal findings
      1. Adjacent discs with >3.5 mm horizontal displacement
      2. Displaced apophyseal joints
      3. Wide disc spaces
      4. Disc height >30% loss
      5. Pre-Vertebral hematoma
  2. Oblique C-Spine XRay (shows foramen)
    1. May be indicated inc chronic radicular symptoms
    2. Largely replaced by MRI Cervical Spine
  • 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]