Computed tomography for clearance of cervical spine injury in the unevaluable patient

To review computed tomography (CT) as a stand-alone test for the clearance of cervical spine injury in the unevaluable patient population.

A PubMed database search was performed using a combination of search terms and Medical Subject Headings. Studies that met inclusion criteria were those with unevaluable patient populations suffering blunt trauma who underwent both CT and magnetic resonance imaging (MRI) of the cervical spine.

Our analysis of 13 articles revealed that a total of 1322 unevaluable patients with a negative CT C-spine who also underwent MRI; 137 of these patients (10%) had positive findings on MRI. Among nine studies with patient management data, a total of 115 patients had positive MRI findings in the setting of a negative CT. Of those 115 patients, 52%, or 60 patients, had changes to their management based on MRI findings. Surgical stabilization was required in three patients, representing 2.5% of the 115 patients with positive MRI findings. The total number of patients in these nine studies who had a negative CT was 855. Therefore, the negative predictive value of a negative CT in this patient population was 92.9% for clinically significant cervical spine injury and 99.6% for cervical spine injury requiring operative intervention.

The evidence supporting CT for the stand-alone evaluation of the cervical spine in the unevaluable patient is insufficient. We contend that a CT of the cervical spine must be supplemented by an additional examination addressing ligamentous instability in this patient population.