title: Do cervical spine X-rays for trauma have clinically significant incidental findings?
abstract: OBJECTIVE
  About 800,000 cervical X-rays for trauma are taken every year in the USA. Those X-rays are reviewed by orthopedic specialists in the emergency room (ER) for traumatic findings. The quantity of incidental atraumatic findings in this very prevalent examination is unknown. We sought to determine the incidence of those findings.
  
  
  METHODS
  We retrospectively reviewed 521 consecutive cervical X-rays of patients with a whiplash injury that visited our ER from February to July 2010. X-rays that were technically insufficient were excluded. This left 356 X-rays that met the inclusion criteria, which were analyzed for incidental findings. The examinations were reviewed by five staff radiologists for incidental findings. The findings were reviewed and classified.
  
  
  RESULTS
  We identified incidental X-ray findings in 22 of the 356 patients (6.2 %) who underwent X-ray of the cervical spine during their visit to the ER. Stenosis with disk narrowing was the most common finding (2.8 %), followed by congenital anomaly of the cervical spine (2.2 %). Other findings were enlarged sella turcica (0.6 %), carotid atherosclerosis (0.3 %), and calcification of the stylomastoid ligament (0.3 %). Older age was found to be a risk factor for an incidental finding (p < 0.0001).
  
  
  CONCLUSIONS
  Incidental findings in the cervical spine were associated with older age. Awareness of the prevalence of incidental findings is important in order to ensure that they are detected and managed appropriately.
authors.affiliation: Division of Orthopedics, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel. 1.koren.lior@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Koren
authors.affiliation: Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Simonovich
authors.affiliation: Division of Orthopedics, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Norman
authors.affiliation: Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Israelit
authors.affiliation: Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Jerdev
authors.affiliation: Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Sherter
authors.affiliation: Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Yagil
authors.affiliation: Department of Radiology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Rozenberg
authors.affiliation: Division of Orthopedics, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Peled
keywords: Cervical; Incidental findings; Trauma
references.citation: Lancet. 1986 Nov 15;2(8516):1120-2
references.pmid: 2877272
references.citation: Chest. 2000 Jan;117(1):43-6
references.pmid: 10631197
references.citation: J Trauma. 2007 Jan;62(1):157-61
references.pmid: 17215748
references.citation: AJR Am J Roentgenol. 2009 Mar;192(3):725-9
references.pmid: 19234270
references.citation: Am J Emerg Med. 2001 Oct;19(6):479-81
references.pmid: 11593466
references.citation: Neurosurgery. 2004 Oct;55(4):897-902; discussion 902-3
references.pmid: 15458598
references.citation: Spine (Phila Pa 1976). 1983 Jan-Feb;8(1):20-7
references.pmid: 6867853
references.citation: Eur Spine J. 2009 Jun;18(6):877-83
references.pmid: 19357877
references.citation: J Emerg Med. 2010 May;38(4):484-9
references.pmid: 19232878
references.citation: Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S52-9
references.pmid: 18204401
references.citation: Surg Neurol. 2005 Jun;63(6):550-3; discussion 553
references.pmid: 15936382
references.citation: Aust Fam Physician. 2007 Nov;36(11):949-50
references.pmid: 18043783
references.citation: Spine (Phila Pa 1976). 1995 Apr 15;20(8 Suppl):1S-73S
references.pmid: 7604354
references.citation: Am J Med. 1976 Nov;61(5):590-6
references.pmid: 984063
references.citation: Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S101-22
references.pmid: 18204385
references.citation: J Trauma Acute Care Surg. 2011 Apr 29;72 (2):416-421
references.pmid: 21537205
references.citation: Vasc Health Risk Manag. 2009;5(1):185-97
references.pmid: 19436645
references.citation: J Trauma. 2005 Jul;59(1):179-83
references.pmid: 16096560
references.citation: N Engl J Med. 2000 Jul 13;343 (2):94-9
references.pmid: 10891516
references.citation: Am J Emerg Med. 2009 May;27(4):428-35
references.pmid: 19555613
references.citation: Pain. 1994 Sep;58(3):283-307
references.pmid: 7838578