The role and limitations of computed tomographic scanning in the evaluation of cervical trauma

We retrospectively reviewed the medical records, plain films, CT scans and complex-motion tomographic studies (TOMOS) of 216 consecutive patients with cervical injuries to determine the uses and limitations of CT in the evaluation of cervical trauma and the indications, if any, for the continued use of TOMOS in evaluating cervical trauma. There were 453 fractures and 104 subluxations or dislocations of the cervical spine in the 216 patients. Plain films detected 58% (262 of 453) of the fractures and 93% (97 of 104) of the subluxations and dislocations; and 94% (202 of 216) of the patients with abnormalities were identified. Computed tomographic scans detected 90% (406 of 453) of the fractures and 54% (56 of 104) of the subluxations and dislocations; 92% (198 of 216) of the patients with abnormalities were identified. Most of the abnormalities missed on the CT scans involved the dens, C-6, and C-7, and were oriented in the axial plane. Although CT scanning was better than plain films in detecting most types of cervical fractures, plain films were better than CT for detecting fractures of the vertebral body, dens, and spinous processes, and significantly better than CT in detecting subluxation and dislocation. When plain films and CT scans were combined they identified 98% (443 of 453) of the fractures and 99% (103 of 104) of the subluxations and dislocations; 100% (216 of 216) of the patients with abnormalities were identified. In the 20 patients who underwent both CT scanning and TOMOS, TOMOS detected more fractures, subluxations, and dislocations than CT scanning. Complex-motion tomographic studies detected atlanto-occipital dislocation and subluxation of the vertebral bodies and fractures of the spinous processes, lateral masses, articular processes, vertebral bodies, and dens better than CT scanning. Although the more routine use of CT scanning in evaluating cervical trauma should increase the detection of cervical abnormalities to near 100%, TOMOS remain the gold standard of diagnosis for atlanto-occipital dislocation, subluxation of the vertebral bodies, and fractures of the lateral masses, articular processes, vertebral bodies, and dens.