Limitation of the cross table lateral view in detecting cervical spine injuries: a retrospective analysis

A city-wide survey of 17 emergency departments revealed that 94.7% of physicians relied exclusively on the cross table lateral view in their initial radiologic disposition of patients suspected of having cervical spine injury, and most of these physicians think it is more than 90% effective in detecting potentially unstable injuries of the cervical spine. A three-year retrospective study was conducted in a midwestern suburban community hospital with 27,000 annual emergency visits to determine the incidence of false negative cross table lateral views of the cervical spine. Of 35 patients with cervical spine fracture/dislocation, we found three cases difficult to diagnose, and six in which this initial view was interpreted as normal. In all nine cases, a standard anteroposterior view (APV) or standard open mouth view (OMV) would have increased the diagnostic yield to 100%. A revised radiologic approach to the patient suspected of having cervical spine injuries is suggested.