[The diagnosis of traumatic cervical lesions: a decade of evidence-based change]

The growing awareness of the need for emergency centers specializing in the care of trauma patients, together with advances in diagnostic imaging technology, have led to the occasional indiscriminate use of diagnostic methods to the detriment of ordering diagnostic tests based on the risk of fracture and of the clinical examination itself. In many institutions, this practice is carried out without appropriate controls and without analyzing the risks and benefits of a particular clinical conduct. This is particularly true in cases of multiple trauma with suspected traumatic lesions of the cervical spine. For many years, radiological examination was based on plain-film radiography, with CT playing a complementary role. Over the last decade, since the introduction of helical CT, and more recently multidetector CT scanners, the diagnostic approach has undergone rapid, significant changes. This article summarizes the experience based on publications centered on establishing the diagnostic effectiveness of CT in comparison to plain-film radiography and the importance of recognizing risk factors when determining the diagnostic strategy. On the other hand, the importance of avoiding unnecessary tests and excessive radiation in providing appropriate and efficient medical care is stressed. In general, the evidence indicates that CT should be the first-line approach in high-risk patients and plain-film radiography should be reserved for the initial evaluation of patients with a low risk of traumatic lesions.