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via Buckeye Surgeon: Traumatic Cervical Spine Injury: Is CT now the preferred imaging modality?.

Over 1500 patients were accrued. Radiographic evidence of cervical spine injury was detected in 78 of the patients, with 50 having clinically significant injuries. Here’s where it gets good. CT scan of the cervical spine detected all 50 injuries (100% sensitivity) while the plain films only identified 18/50. Even in patients with clinically significant injuries, the plain films only had a sensitivity of 46%. The paper concludes by advocating that CT of the cervical spine replace plain c-spine radiographs as the preferred initial test to exclude blunt cervical injury.

This is a classic case of where the data has finally caught up to what actually happens in real life. (Got that, you CER disciples? Science isn’t as accomodating or as quick as we would like. The proof of what is already apparent in clinical practice can lag years behind.) I cover trauma at a level II center and I’ll be honest; I don’t spend a lot of time looking at plain films of the neck. They’re always sort of suboptimal and don’t consistently show all the vertebrae you need and if there’s a question, you’re just going to get a CT cervical spine anyway. So I go straight to the CT films.

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Good of you, Buckeye. I agree completely.

The Head CT protocol for trauma victims in my department uses a helical scan plan that goes from the mandible to the vertex. This covers at least up to the fifth cervical vertebra in most patients.

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[The green box represents the area to be scanned]

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[Midsagittal MPR image showing Cervical vertebrae up to superior endplate of C6]

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[VR image - left lateral view showing normal skull, facial bones, mandible and cervical spine. Bonus point for identifying the structure caudal to the mandibular ramus]

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[VR image - RAO view. Bonus points for identifying the fractures and the anatomical variant]

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Usually the films and my report would be confined to describing the findings (if any) in the brain, skull and facial bones if no spinal injury is found. This being India, where the vast majority of healthcare spending is from the patients’ pockets (my friend George has a great term for it OOPS = Out Of Pocket Spending), cost concerns are supreme and there is no additional charge for the inclusion of the facial bones and/or cervical spine related information in the Head CT report.

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