Essentiality of the lateral cervical spine radiograph

Proper interpretation of the lateral cervical spine (C-spine) film is a prime emergency medicine responsibility. Patients with potential neck injury must be identified rapidly and handled carefully; their C-spine films must be interpreted quickly and accurately. We stress the urgency in obtaining a good, readable lateral C-spine film and present a systemic "ABCs" approach to reading this film. This approach includes specific, sequential attention to Alignment, Bony integrity, Cartilaginous structures, and the surrounding Soft-tissue spaces. In the cases of 50 consecutive patients with C-spine injuries (49 adults, one child) seen recently in our emergency medicine program, we have correlated traumatic mechanisms with specific injury patterns. These analyses have been meshed with data from the patients' medical records and radiographs. In a significant number of instances (greater than 25% in this series), objective, careful radiographic interpretation is more important to the patient's objective, careful radiographic interpretation is more important to the patient's welfare than is any other diagnostic modality -- including history and physical examination.