Helical Computed Tomographic Scanning for the Evaluation of the Cervical Spine in the Unconscious, Intubated Trauma Patient

Abstract

Helical CT scanning of the cervical spine allows rapid and safe evaluation of the cervical spine in the unconscious, intubated trauma patient.

Comparison of Low-Dose With Standard-Dose Multidetector CT in Cervical Spine Trauma

“…22 Subsequently, CT should be the initial screening test in those patients, especially when there is a significantly depressed mental status. 22 This has been shown in multiple recent studies [3][4][5][6][7][8][9][10] : plain radiographs need not to be obtained in those patients, and the Eastern Association for the Surgery of Trauma guidelines 24,25 for cervical spine evaluation of blunt cervical spine trauma should be updated to reflect this evolving practice pattern. 6 Clinical evaluation of the neck can reliably rule out significant CSI in the awake and alert blunt trauma patients, so they do not need imaging.…”

“…The optimal imaging protocol for cervical spine clearance in patients with blunt trauma, especially in unconscious patients with traumatic brain injury, remains controversial. [2][3][4][5][6][7][8][9][10]22 With the proliferation of helical and MDCT, it became clear how poor standard radiography can be for the assessment of cervical spine fractures compared with CT. In a meta-analysis, the percentage of missed fractures on radiography versus CT was found between 1.5% and 52.0%, 22 whereby it is accepted that 10%-20% of significant CSIs are missed by using radiographs.…”

“…2 Multiple recent studies add to a growing body of evidence that MDCT should replace standard radiography in patients with blunt trauma who require radiographic evaluation of the cervical spine and in unconscious patients with severe head trauma, whereby standard radiography becomes unnecessary. [3][4][5][6][7][8][9][10] But only a small number of these patients will have a significant cervical spine injury (CSI): there is only a 2%-6% incidence of significant cervical spinal injury in the symptomatic population after acute trauma. 2,11,12 Therefore, most of these patients, many being young and otherwise healthy persons, will undergo a much larger radiation dose for their cervical spine clearance.…”

Clinical review: spinal imaging for the adult obtunded blunt trauma patient: update from 2004

“…The sensitivity of plain radiographs to detect significant 2 spinal injuries, including the three view combination of anteroposterior, lateral and open mouth 'odontoid' views ranges widely from 31 to 94% [12,14,15,17,18,23,24,30]. Usefully Holmes quoted a pooled sensitivity of 52% [22].…”

Enhancing Evaluation of Cervical Spine: Thresholds for Normal CT Relationships in the Subaxial Cervical Spine

“…1 The basis for this recommendation was the superior sensitivity of CT (90%-100%) for detecting traumatic bony injury, making plain radiographs in this setting almost obsolete. [2][3][4][5][6][7] Although CT is commonly used to identify fractures and to screen trauma patients, there is very little published data regarding normal subaxial spine relationships on CT. Normal bony relationships, such as ISD, have not been well defined despite the superior resolution and lower susceptibility to magnification error. The purpose of this study was to describe normal anatomical features, including CT based landmarks, of the subaxial disks and facet joints of the cervical spine on CT scan in an asymptomatic population.…”