Efficacy of the posttraumatic cross table lateral view of the cervical spine

This is a retrospective study of 128 patients with a discharge diagnosis of cervical spine fracture, dislocation, or subluxation. The study was undertaken to establish the accuracy of the posttraumatic cross table lateral view radiograph of the cervical spine (CTLV). The radiographs were read by the faculty emergency physician author. If his diagnosis differed from the patient's final radiologic diagnosis, the radiograph was reevaluated by the radiologist author. The accuracy in diagnosing posttraumatic cervical spine abnormalities on CTLV alone was 74.2% and 79.7% for the emergency physician and radiologist, respectively. Thirty percent of cases undiagnosed by the emergency physician were subsequently treated as unstable injuries. Thirty-five percent of C1, 14.8% of C2, and 42.4% of C6 abnormalities were missed on CTLV by both the emergency physician and the radiologist. The results indicate that the CTLV, alone, is unreliable and potentially dangerous as a screening exam in diagnosing posttraumatic abnormalities of the cervical spine.