X-ray of the cervical spine in trauma
Author:
Mikael Häggström [notes 1]
Contents
Planning
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]
Evaluation
- Incongruences?
- Prevertebral thickening? [notes 2]
- Any fracture lines?
Incongruencies
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 spinous processes should be compared.
Prevertebral thickening
Upper limits of values vary with body constitution of the patient, but are generally as follows:
- Children: Less than 6 mm at the level of C3[6]
- Adults: Less than 6 mm at C2 and less than 22 mm at C6[6]
Thresholds are higher on CT.[notes 2]
Report
Even absence of:
- Fracture
- Misalignment
- Prevertebral thickening
See also
Notes
- ↑ 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.
- ↑ 2.0 2.1 In contrast, CT of the neck in trauma has a higher sensitivity in directly visualizing skeletal injuries, making it optional to evaluate the indirect sign of prevertebral thickening. Hence, the threshold for prevertebral thickening is higher when evaluating CTs.
- Further information: CT of the neck in trauma
References
- ↑ 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:. ISSN 14651858.
- ↑ Julie C Leonard (2018-02-12). Evaluation and acute management of cervical spine injuries in children and adolescents. UpToDate.
- ↑ 3.0 3.1 . Head injury: assessment and early management. National Institute for Health and Care Excellence (NICE) (2014). Updated in June 2017
- ↑ . Traumamanual. Region Skåne. Last updated: 2018-03-29
- ↑ Amy Kaji, Robert S Hockberger (2018-05-24). Evaluation and acute management of cervical spinal column injuries in adults.
- ↑ 6.0 6.1 Debnam, J. Matthew; Guha-Thakurta, Nandita (2012). "Retropharyngeal and Prevertebral Spaces ". Otolaryngologic Clinics of North America 45 (6): 1293–1310. doi:. ISSN 00306665.
