Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma

The three-view trauma series has been the standard screening examination for patients with cervical spine trauma. We conducted a prospective study to determine if the addition of supine oblique views to the three-view series would improve detection of fractures, subluxations, dislocations, or locked facets. All patients over a two-year period with suspected cervical spine injury had a five-view series obtained (three-view series and supine oblique views), and selected high-risk patients underwent thin-section conventional tomography of the cervical spine. Films were interpreted separately by two radiologists and an emergency physician, and the tomography results were used as the gold standard for comparison. Thirty-three of 58 high-risk patients had one or more fractures, subluxation, or dislocation demonstrated on tomography. There were no fractures or dislocations detected on the five-view series that were not detected or suspected on the three-view series. In areas of the cervical spine reported to be better visualized by supine oblique views than three-view series, our results indicate that supine oblique views did not improve detection but did, in certain cases, allow more specific diagnosis of injuries. Our data do not support the routine use of supine oblique views in the initial radiographic evaluation of patients with cervical spine trauma.