Unstable C-spine injury with normal C-spine radiographs

Abstract

SUMMARYThere is some controversy surrounding the optimal mode of imaging in trauma patients with suspected cervical (C) spine injury. Various rules (most notably the Canadian Cspine rules and the NEXUS rules) have been designed to help reduce the need for imaging given the poor yield. Some authorities advocate CT for almost all cases whereas others advocate three view radiographs unless the patient is at high risk, in which case CT is the preferred choice. One meta-analysis showed sensitivity of 58% (39-76%) for plain radiographs and 98% for CT in identification of C-spine injuries following blunt trauma. This case report illustrates how very unstable Cspine injuries may not be apparent on plain radiographs and a degree of clinical suspicion may be required for further imaging. BACKGROUND

Atlanto-axial subluxation secondary to a neglected odontoid fracture

“… 4 Therefore, in cases of suspected C-spine injury, CT should be used as the primary imaging modality. 5 However, some fragile bone fractures in older patients cannot be identified using C-spine CT, and in cases of unexplained, persistent pain, MRI should be considered as an alternative. Further, subclinical fractures in other regions of the spine and pelvis should be investigated.…”