Diagnosing cervical spine instability: role of the post-computed tomography scan out-of-collar lateral radiograph.
BACKGROUND
Cervical spine injuries may have devastating neurological consequences, which makes accurate diagnosis of injury a key part of the trauma evaluation. Imaging plays a significant role in making the diagnosis and guiding management. Current American College of Radiology Appropriateness Criteria guidelines recommend computed tomography (CT) of the cervical spine with multi-planar reformats as the highest-rated imaging examination for patients meeting clinical criteria, without subsequent need for further imaging with a negative scan in a neurologically intact and non-obtunded patient. Although CT is fast and accurate for evaluation of bony injury, it may overlook ligamentous injury.
We report a case in which ligamentous instability was demonstrated as subluxation with an out-of-collar lateral radiograph after a CT scan showed no subluxation or fracture in a patient without neurological deficits. Our Radiology Department routinely performs an out-of-collar lateral radiograph after a negative CT scan, and this case suggests that there may be an important role for this practice.


CONCLUSIONS
Magnetic resonance is the optimal study for soft tissue and ligamentous evaluation; however, a simple lateral out-of-collar radiograph after CT clearance, in an otherwise neurologically intact and non-obtunded patient, may be a quick and cost-effective means to assess for instability of the cervical spine.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Alexander
A
Ding
Hani
H
Abujudeh
Robert A
RA
Novelline
D000058:Accidental Falls; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging*; D007593:Joint Instability / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*