CT's for Suspected Cervical Spine Injuries

An excerpt from the American College of Emergency Physicians' website:

A new study indicates that patients sustaining a cervical spinal injury (CSI) may harbor additional spinal damage that is not visible on regular x-rays. In fact, more than 36 percent of patients with low-risk injuries actually have additional occult damage that may include significant fractures with the potential to produce serious spinal problems if not detected and treated properly. This study will be published as an early online release by Annals of Emergency Medicine (Injuries Missed by Limited Computed Tomographic Imaging of Patients with Cervical Spine Injuries).

This study stands in the face of previous medical thinking in which patients with certain forms of spinal injury were considered at very low risk of having additional such injuries. Because of that low risk, physicians were urged to use plain x-rays and avoid computed tomography (CT) in evaluating these cases.

"These findings are significant because they suggest that CT imaging, which allows physicians to view the spine in much greater detail, is necessary in evaluating all patients who have radiographic evidence of cervical spine injuries," said lead study author William Mower, MD, PhD, of the UCLA Emergency Medicine Center. "What we found was that even among patients with low-risk injuries, more than one-third sustained secondary damage that was not diagnosed by plain radiography. In fact, approximately one-fourth of these secondary injuries occurred in another part of the cervical spine, which suggests that at least some of these patients may have actually sustained two separate spinal injuries. Furthermore, we believe that our finding that plain radiographs failed to detect secondary injuries in 81 of the 224 patients with identified CSIs is likely an underestimate, and the true prevalence of missed injury is probably even greater."

The authors believe that patients with any evidence of CSI, including those with CSIs previously considered to be at low risk for secondary injuries, should undergo CT imaging of the entire cervical spine. CT should be obtained both to determine whether secondary injuries are present and to identify those non-contiguous injuries that, in fact, occur in a substantial number of cases.