Roentgenographic Evaluation of the Cervical Spine

Abstract

These results indicate that blunt trauma patients may not require cervical spine roentgenography if they meet the following criteria: absence of mental status changes, intoxication, neck pain or tenderness, neurologic signs or symptoms, or simultaneous major distracting injury. Because of the small incidence of cervical spine injuries, further studies are necessary to evaluate the positive predictive value of history and physical examination of the cervical spine in a trauma patient.

Clinical Examination in Complement With Computed Tomography Scan: An Effective Method for Identification of Cervical Spine Injury

“…There continues to be debate over the optimal radiologic and diagnostic methodology with regard to the effective utilization of clinical examination, plain radiographs, and CT scan in the identification of c-spine injury. [1][2][3][4][5][6][7][8][9][10][11][12][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Clinical examination has been shown to be a reliable method for the identification of blunt trauma patients who may be clinically cleared or who may require further diagnostic testing for c-spine injury clearance. [1][2][3][4][5][6][7][8][9][10][11][12] In this series, Pelvic fx, femur fx, facial fx, ankle fx, skull fx C 2 Hangman's fx, C 2 on C 3 sublux 3…”

“…Recent studies suggest that clinical examination of the neck is sensitive for determination of c-spine injury in the awake and alert evaluable blunt trauma patient. [1][2][3][4][5][6][7][8][9][10] The results of the c-spine clinical examination often determine the need for further radiologic screening. Many trauma centers rely on routine radiologic evaluation of the c-spine for injury screening.…”

Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

“…33 Many trauma experts believe that a selective approach is preferable but do not provide clear recommendations. 10,11,13,16,22,[34][35][36][37] Most authors feel that radiography is unnecessary in alert patients with no neck pain or tenderness, 5,7,9,12,14,18,[23][24][25][38][39][40][41][42][43][44][45] but only a few are willing to suggest that imaging might be withheld in alert patients with pain but no midline bony tenderness. 15,17,19 Emergency practice is characterized by high case volumes, brief physician-patient contact, uncertain followup and fear of medicolegal repercussions.…”

“…But Canadian and US emergency physicians have differing views on this topic, 49,50 and the consensus is that more research is necessary before C-spine radiography guidelines for alert trauma patients can be implemented. 7,9,11,14,16,17,19,20,24,34,[37][38][39][40]44 Future studies should be rigorous, prospective and involve large numbers of patients.…”

“…Only a few studies gathered data prospectively using data collection forms, 9,10,15,17,19,40,44,45,52 no study described training the physicians to collect data in a standardized fashion, and no study explicitly collected the predictors without knowledge of the outcome. Only 1 study measured interobserver agreement to assess reliability.…”