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Cervical spine trauma: how much more do we learn by routinely using helical CT?
D B Nuñez1, A Zuluaga, D A Fuentes-Bernardo
1Department of Radiology (R-109), Jackson Memorial Hospital, University of Miami School of Medicine, FL 33101, USA.
Summary
Many cervical spine fractures are missed on initial X-rays in trauma patients. Helical computed tomography (CT) can identify these missed injuries, improving diagnosis and patient care for suspected cervical spine trauma.
Area of Science:
- Trauma Care
- Radiology
- Orthopedic Surgery
Background:
- Cervical spine injury assessment is critical in trauma care.
- Radiography often misses or incompletely shows cervical spine fractures, especially in obtunded patients.
- Suboptimal imaging contributes to missed diagnoses.
Purpose of the Study:
- To determine the type, distribution, and significance of missed cervical spine fractures.
- To compare radiography with helical computed tomography (CT) for detecting these fractures.
- To evaluate the clinical impact of missed cervical spine injuries.
Main Methods:
- Retrospective review of 88 severely traumatized patients.
- Comparison of cervical spine radiographs and helical CT scans.
- Analysis of medical records for missed fracture identification.
Main Results:
- 32 of 88 patients had 50 cervical spine fractures missed or incompletely shown on radiography.
- Missed fractures were common at C1-C2 and C6-C7 levels, involving transverse processes and posterolateral elements.
- One-third of patients with missed fractures had clinically significant or unstable injuries.
Conclusions:
- Helical CT effectively depicts significant cervical spine fractures missed by plain radiography.
- Routine addition of helical CT to initial screening is recommended for polytrauma victims with suspected cervical spine fractures.