Role of Cervical Spine Radiography in Initial Evaluation of Stable High Energy Blunt Trauma Patients

Abstract

Background: In a trauma patient detecting the cervical spine injuries is one of the most important matter because undetected injuries in the cervical spine may result in severe neurological disability probably quadriplegia. Thus radiography of the cervical spine is considered mandatory in initial evaluation of a trauma patient according to the Advanced Trauma Life Support (ATLS). This approach results in high number of normal radiographies which can be referred as unnecessary radiographies. Thus we performed this study in order to determine the role of routine cervical radiography in initial evaluation of stable high energy blunt trauma patient.

Materials and Methods: This was a prospective cross-sectional study including all the hemodynamically stable high energy blunt trauma patients with negative cervical physical examination referring to our trauma center during a 5-month period (May to September 2010). Cervical radiographies, computed tomography (CT) scanning and magnetic resonance imaging (MRI) were performed and reviewed for abnormalities.

Results: During the study period, 1679 high energy blunt trauma patients referred to our center out of which 400 were hemodynamically stable and had negative cervical physical examination. Cervical radiographies were found to be normal in all the patients. 

Conclusion: Cross-table cervical spine radiographies can be limited to those high energy blunt trauma patients who have positive cervical physical examination or those in whom physical examination is not revealing. These radiographies also have low value for detecting occult cervical spine fractures and CT imaging is considered the modality of choice in these cases.

 Keywords: Cervical Radiography; Blunt Trauma; Spine