CT of the neck in trauma

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Author: Mikael Häggström [notes 1]


Indication for imaging

In neck trauma, a normal clinical evaluation may clear the neck without diagnostic imaging, such as using the the Canadian C-spine rule.[1] In practice, there is rarely any reason for a radiologist to decline an imaging request from a clinician for a trauma patient.

Choice of modality

Recommendations differ somewhat between children and adults:

  • In children, CT of the neck in trauma is indicated in more severe cases such as neurologic deficits, whereas X-ray of the cervical spine is preferable in milder cases, by both US[2] and UK[3] guidelines. Swedish guidelines recommend CT rather than X-ray in all children over the age of 5.[4] It is thus reasonable to indicate CT by a combination of higher severity and older age.
  • In adults, UK guidelines are largely similar as in children.[3] US guidelines, on the other hand, recommend CT of the neck in trauma in all cases where medical imaging is indicated, and that X-ray of the cervical spine is only acceptable where CT is not readily available.[5]


  • Thin slices, ideally 1.5 mm or less.[6]
  • Should include first thoracic vertebra.[7]


  • Incongruences?
  • Prevertebral thickening? Optional[notes 2]
  • Any fracture lines?


Lines drawn along the anterior and posterior surfaces of vertebrae as well as the spinous processes should be smooth.

Also, the distances between vertebrae, and between spinous processes should be compared.

Fracture lines

If not already found by the above signs, scroll through the stack to look for fracture lines, at least through axial and sagittal images. If found, see CT of neck fractures.

Optional: Prevertebral thickening

Upper limits of values vary with body constitution of the patient, but in adults they are generally as follows:[8]

CT of prevertebral space.jpg

The following are upper limits for prevertebral spaces in children:[9]

Age C2 C6
0-2 years 7.6 mm 9.0 mm
3-6 years 8.4 mm 9.8 mm
7-10 years 6.8 mm 12.1 mm
11-15 years 6.8 mm 14.5 mm

Thresholds are lower on X-rays.[notes 2]


Even absence of:

  • Fracture
  • Misalignment

Optionally, even absence of prevertebral thickening.[notes 2]

General notes on fracture reporting

See also


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
  2. 2.0 2.1 2.2 In contrast, X-ray of the cervical spine in trauma has a lower sensitivity in directly visualizing skeletal injuries, putting high importance on the indirect sign of prevertebral thickening important in the evaluation. Hence, the threshold for prevertebral thickening is less when evaluating X-rays.
    Further information: X-ray of the cervical spine in trauma


  1. Saragiotto, Bruno T; Maher, Christopher G; Lin, Chung-Wei Christine; Verhagen, Arianne P; Goergen, Stacy; Michaleff, Zoe A (2018). "Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) for detecting clinically important cervical spine injury following blunt trauma ". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD012989. ISSN 14651858. 
  2. Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
  3. 3.0 3.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
  4. . Traumamanual. Region Skåne. Last updated: 2018-03-29
  5. Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
  6. Tins, Bernhard (2010). "Technical aspects of CT imaging of the spine ". Insights into Imaging 1 (5-6): 349–359. doi:10.1007/s13244-010-0047-2. ISSN 1869-4101. 
  7. Mark Karadsheh. Cervical Spine Trauma Evaluation. Orthobullets. Updated: 4/24/2019
  8. Rojas, C.A.; Vermess, D.; Bertozzi, J.C.; Whitlow, J.; Guidi, C.; Martinez, C.R. (2009). "Normal Thickness and Appearance of the Prevertebral Soft Tissues on Multidetector CT ". American Journal of Neuroradiology 30 (1): 136–141. doi:10.3174/ajnr.A1307. ISSN 0195-6108. 
  9. Francis Deng and Jeremy Jones. Perivertebral space. Radiopaedia. Retrieved on 2019-05-08.