Is the anteroposterior cervical spine radiograph necessary in initial trauma screening?

doi:10.1016/0735-6757(91)90206-Y

The American Journal of Emergency Medicine

Volume 9, Issue 5, September 1991, Pages 421-425

https://doi.org/10.1016/0735-6757(91)90206-Y Get rights and content

Abstract

The usefuiness of the anteroposterior (AP) radiograph of the cervical spine in contributing to the diagnosis of cervical spine injuries in the acute trauma patient was examined in a retrospective study. All cases of cervical spine fracture or dislocation seen at a level I trauma center over a 3-year period and at a rehabilitation center over a 10-year period were reviewed. The lateral radiograph, open-mouth odontoid radiograph, and AP radiograph of each case were sequentially examined by a neuroradiologist (blinded to the original diagnosis) to determine the contribution of each view in making a diagnosis of cervical spine injury. Results of these reviews showed that there were no cases of cervical spine injury evident on the AP view without an obvious corresponding abnormality on the lateral or open-mouth view. It was concluded that the AP view could be dropped from the initial screening radiographic study of the cervical spine in the trauma patient. Only an adequale lateral view and open-mouth odontoid view would then be necessary to initially evaluate the cervical spine in the trauma patient, and decisions to obtain further studies could be based safely on only the lateral and open-mouth views.

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Cited by (27)

Adherence to the guidelines of paediatric cervical spine clearance in a level i trauma centre: A single centre experience
2016, European Journal of Radiology
Citation Excerpt :
In total in 37 children under the age of 8 only a lateral view was obtained. Previous literature debated whether the AP-view has additive value [22,23]. However, international guidelines still suggest a lateral and AP-view in all children under the age of 8 year [4–7].
International guidelines define if and what type of radiography is advised in children to clear the cervical spine (C-spine). However, adherence to these guidelines has never been evaluated in a paediatric population. Therefore, we wanted to assess the adherence to the guidelines for C-spine clearance in a level-one trauma centre.
We retrospectively included all children, presented at the ED between January 2006 and December 2013, in whom radiographic imaging of the C-spine was obtained following blunt trauma. Primary outcome was the adherence to the international guidelines with regard to (1) if the indication for radiographic imaging was correct and (2) if the type of radiographic imaging was correct.
Included were 573 patients; 336 boys (58.7%). Median age was 11 years (IQR 5.25-15). The indication for radiographic imaging was correct in all cases. The type of primary imaging modality was concordant with the guidelines in 99,7%. In 41% of the cases supplementary radiographs were made. The most common supplementary view was the odontoid. In 15% an incomplete set of radiographs was obtained.
The adherence to the international guidelines when to obtain radiographic imaging was 100%. However, in a large proportion of patients (56%), not the recommended number of radiographs was obtained.
Radiological management of patients with multiple trauma:History and current practice
2010, Radiologia
El radiólogo desempeña un papel crucial en el manejo multidisciplinar del paciente politraumatizado, que en las últimas décadas ha sufrido un cambio evolutivo desde la radiología simple hasta la tomografía computarizada multidetector de cuerpo completo, propiciado por los avances tecnológicos y los cambios culturales sanitarios.
En este artículo se muestra la evolución de los diferentes protocolos y la situación actual del manejo del paciente politraumatizado.
El radiólogo integrado en un equipo multidisciplinar debe decidir la técnica de imagen y el protocolo más idóneo en cada situación, adaptándose a los recursos tecnológicos disponibles.
The radiologist plays a crucial role in the multidisciplinary management of patients with multiple trauma. In the last few decades, technological advances and changes in the healthcare culture have led to changes in the imaging work-up of multiple trauma patients, with emphasis shifting from plain-film radiography to whole-body multidetector CT.
This article describes the evolution of the different protocols and the current practice in the management of patients with multiple trauma.
As a member of the multidisciplinary team, the radiologist must decide on the best imaging technique and protocol for each situation in function of the technological resources available.
Fracture of the odontoid process in children: A case report
2009, Orthopaedics and Traumatology: Surgery and Research
Fracture of the odontoid process in children: A case report
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Advances in Imaging the Traumatized Cervical Spine
2007, Seminars in Spine Surgery
Imaging the cervical spine in the acute trauma patient continues to spark controversy and debate. Although several organizations have attempted to established guidelines for the evaluation of the cervical spine following blunt trauma, a universally accepted consensus on which imaging modalities should be employed and the timing of their acquisition has not been achieved. This article reviews the current standard of care for the evaluation of the cervical spine following blunt trauma, as well as updating the current controversies surrounding this issue.
ACR Appropriateness Criteria<sup>®</sup> on Suspected Spine Trauma
2007, Journal of the American College of Radiology
Citation Excerpt :
Conservative estimates in the literature indicate that more than 1 million blunt trauma patients, who have the potential for sustaining cervical spine injuries, are seen in emergency departments in the United States each year. The original literature reviewed for the cervical portion of this ACR Appropriateness Criteria® topic included the initial investigations of 5,719 patients with cervical trauma [1-13]. The literature review for this revision includes data on more than 55,000 patients [14-32], including findings of the National Emergency X-Radiography Utilization Study (NEXUS) on 34,069 patients [23] and from the Canadian C-Spine Rule (CCR) group on 8,924 patients [29].
The evaluation of patients with suspected spine trauma is controversial. This document addresses several pertinent issues: (1) which patients need imaging, (2) how much imaging is necessary, and (3) exactly what sort of imaging is to be performed. This subject is important, because conservative estimates indicate that more than 1 million blunt trauma patients, who have the potential for sustaining spine injuries, are seen annually in emergency departments in the United States. Adult patients who satisfy any of several “low-risk” criteria for cervical spine injury need no imaging. Patients who do not fall into this category should undergo thin-section computed tomographic examinations that includes sagittal and coronal multiplanar reconstructed images. For those patients who cannot be examined using computed tomography, 3-view radiographic examinations of the cervical vertebrae may be performed to provide preliminary assessments of the likelihood of injury until computed tomography can be performed. Thoracic and lumbar computed tomographic images may be obtained from data collected for thorax-abdomen-pelvis studies. Radiography is recommended for children under 14 years of age. Reconstructed computed tomographic images may be used from thorax-abdomen-pelvis studies of children, if they have been obtained. Magnetic resonance imaging should be the primary modality for evaluating possible spinal cord injury or compression as well as ligamentous injuries in acute cervical spine trauma. Flexion and extension radiography is best reserved for follow-up of symptomatic patients, after neck pain has subsided.

View all citing articles on Scopus

^☆: Presented at the 20th Annual Meeting of the Society for Academic Emergency Medicine, Minneapolis, Minnesota, May 1990; and at the Emergency Medicine Research Society/Society for Academic Emergency Medicine Combined Meeting, Edinburgh, Scotland, October 1990.

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Original contributionIs the anteroposterior cervical spine radiograph necessary in initial trauma screening?☆

Abstract

Ann Emerg Med

Ann Emerg Med

J Emerg Med

J Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Orthop Clin North Am

Ann Emerg Med

Ann Emerg Med

Radiological diagnosis of cervical trauma at the level C7T1

Arch Orthop Trauma Surg

The usefulness of flexion-extension cervical spine radiographs in trauma patients with neck pain

CT in the evaluation of spine trauma

Am J Radiol

Clinical indications for cervical spine radiographs in the traumatized patient

Am J Surg

Original contribution
Is the anteroposterior cervical spine radiograph necessary in initial trauma screening?☆

Radiological diagnosis of cervical trauma at the level $C7 T1$