Cervical Spine CTs for Trauma


Interesting study found in Medscape that was presented at the ACEP conference this year. In this study, cervical spine CT scans detected 100% of clinically significant cervical spine injuries while 3 view cervical spine x-rays detected only 33% of clinically significant cervical spine injuries.
If these numbers are able to be replicated, should we continue performing cervical spine x-rays in trauma patients?cspine-xray.jpg

About 10,000 Americans have cervical spine injuries each year, and delayed diagnosis has important clinical and economical costs. CSRs have a reported sensitivity ranging from 35% to 89%; the study authors conducted a study to determine whether CCT has greater sensitivity in the detection of these injuries than CSR.

They carried out a prospective study of patients who presented with blunt trauma during the course of 23 months at an urban public hospital’s trauma center. Patients received both a 3-view CSR and CCT, each read independently by attending radiologists who were blinded to other tests.

Of 1580 study patients, 60 (4%) had injuries that were detected by CSR or CCT. CSR detected the injury in 21 of these patients (35% sensitivity), whereas CCT detected injuries in 58 patients (97% sensitivity). Of the 60 patients, 45 had injuries that were considered clinically significant (defined as requiring an operating room procedure, halo application, or hard collar). CCT identified all of these cases (100% sensitivity), whereas CSR detected just 15 injuries (33% sensitivity). In 2 cases, injury was identified by CSR and not CCT, but neither injury was clinically significant.

The study had some limitations, including the fact that it was conducted at a single institution and that 78 patients were dropped because of protocol violations. There was also no structured follow-up.


  1. I practiced radiology for 25 years and a large part of my job was reading C spine films taken in the ER on trauma patients.

    Over the years, when Hi-res CAT scans became available, we started doing a CAT scan in addition to the plain film and discovered that many of the negative plain films were actually positive for subtle fracture on CAT scan.

    This is just a limitation of the plain film technique and a testiment to the added resolution in the axial plane of the CAT scanner. The soft tissues from the shoulders makes plain film imaging especially around C7-T1 difficult.

    Jeffrey Dach MD

  2. CT = 10 Minutes
    Plain Films = 45 Minutes(could be longer or shorter depending on how fast the crosstable lat can be cleared)

    CT has better images.

    CT has better reliability.

    No brainer.

  3. I have never understood why we get c, t and l films on our level 1 and 2 trauma patients after we ct them, especially since I have seen plenty fractures that were captured by ct that xray missed, but never have Iseen one captured by xray that ct has missed, know any reason why we do both? And FYI, we always go to ct first, not the xray.

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