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Cervical Spine Trauma

When to X-ray

  1. High Energy Multiple Injury

  2. Head Injury with neck pain

  3. Hyperflexion / extension Injury with neck tenderness (over midline)

  4. ?? drunk/uncooperative patients

Which X-rays?

  1. Lateral

  2. AP

  3. Open mouth (odontoid peg) views

  4. +/- Oblique views

  5. +/- Flexion extension views to diagnose instability

  6. +/- C T Scan

  7. +/- MR scan

Sensitivity of Lateral C spine X-ray alone is 70-85%

Sensitivity of 3 series- (AP, lateral and open mouth views) is 80-95%

Sensitivity if CT added is 95-100%

 If a cervical spine fracture is found:

  • 50% have a fracture at an adjacent level

  • 15% have a fracture in another part of the cervical spine

  • 10% Have fractures in thoracic/ lumbar spine

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