[Radiological assessment protocol in injuries of the cervical vertebrae]

Over 3000 cases of soft tissue injuries of the cervical spine are reported annually to SUVA (Swiss accident insurance). Although the majority of the patients are pain-free within 4 weeks, it appears that approximately a quarter of those injured still experience neck pain even years after the accident. The initial radiological assessment should include an AP and a lateral plain X-ray of the cervical spine, and in the case of radicular symptomatology oblique views are also recommended. Should the symptoms persist for more than 6-8 weeks after the accident, functional X-rays in flexion/extension and lateral flexion should also be performed. If no instability can be demonstrated by plain X-rays and symptoms are still present and severe enough to limit the patient's working capacity after 3 to 6 months despite conservative therapy, further neuroradiological investigations, including functional CT's, are indicated. The decision to perform these investigations should lie with an interdisciplinary spinal team. Close cooperation between the clinicians and the radiologists is of utmost importance to ensure that the optimal radiological investigation can be performed on the basis of the clinical findings.