[Imaging strategy for cervical spine injury].
MAKING THE DIAGNOSIS: Exploration strategies when faced with a suspected spine injury have improved with the recent development of new imaging techniques (notably the helical CT scan). A selection must be made between the techniques available in order to optimise diagnostic habits. THE FUNDAMENTAL POINTS: The clinical examination identifies the small group of patients that does not require radiographic exploration. When cervical lesions exist, they are often multiple and layered. This justifies the fact that, if an exploration of the cervical spine is proposed, it should be complete and include the upper and lower hinges. The quality of the standard images (face, profile, mouth open) varies greatly. Their negative quality and predictive value decreases when the severity of the injury increases. PARTICULAR EXAMINATIONS: Scanning is the most efficient technique for not only detecting but also formally eliminating an injury. Its indications should therefore be extended but also limited to a selected population. The MRI is currently a second line examination, indicated for any suspicion of a neurological lesion, notably of the bone marrow. Lesions of the ligaments are often missed and should be systematically searched for using dynamic imaging. These can be done at distance from the injury.
Gerbeaux
Patrick
P
Service d'accueil des urgences, Hôpital de la Conception, Marseille. pgerbeaux@mail.ap-hm.fr
Portier
François
F
D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D006801:Humans; D011859:Radiography; D013124:Spinal Injuries / Q000175:diagnosis / Q000453:epidemiology; D014463:Ultrasonography