title: Are soft tissue measurements on lateral cervical spine X-rays reliable in the assessment of traumatic injuries?
abstract: BACKGROUND
  Traumatic neck pain is a common presentation to the emergency department. Lateral plain radiographs remain the primary investigation in the assessment of these injuries. Soft tissue assessment forms an integral component of these radiographs. They can provide information on subtle injuries that may not be obvious. Many methods are used to assess the prevertebral soft tissue shadows. The two more commonly used techniques include the 'seven at two and two at seven' rule (method 1) and the ratio of the soft tissues with respect to the vertebral width (method 2).
  
  
  OBJECTIVE
  To assess which of the above two methods in assessing cervical spine soft tissue shadows on lateral radiographs is more sensitive in the presence of cervical spine injuries.
  
  
  METHODS
  A retrospective analysis of consecutive traumatic cervical spine films performed within a busy trauma tertiary centre over a period of 7 months. Patients were divided into two groups: group 1-fractures; group 2-no fractures. The prevertebral soft tissue shadows were measured at referenced points on the lateral cervical spine films with respect to the above two methods and comparisons between the groups were made.
  
  
  RESULTS
  Thirty-nine patients in group 1 were compared to a control group of 60 patients in group 2. Both methods failed to identify any significant differences between the two groups. The sensitivity and specificity for method 1 was 7.6 and 93 %, and for method 2, they were 7.6 and 98 %, respectively.
  
  
  CONCLUSIONS
  There is no significant difference between the soft tissue shadows when comparing patients with and without cervical spine fractures on lateral radiographs. Both commonly used measures of soft tissue shadows in clinical practice are insensitive in identifying patients with significant osseous injuries. They, therefore, do not offer any further value in interpreting traumatic cervical spine radiographs. The management of patients with cervical spine trauma in the absence of obvious osseous injury on standard radiographs should warrant a computed tomography (CT) scan if clinically indicated.
authors.affiliation: Trauma and Orthopaedic Department, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK. Shaqs@doctors.org.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Patel
authors.affiliation: Trauma and Orthopaedic Department, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: S
authors.initials: S
authors.lastname: Grannum
authors.affiliation: Trauma and Orthopaedic Department, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Tariq
authors.affiliation: Trauma and Orthopaedic Department, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Qureshi
authors.affiliation: Trauma and Orthopaedic Department, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: A
authors.initials: A
authors.lastname: Watts
authors.affiliation: Trauma and Orthopaedic Department, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: O
authors.initials: O
authors.lastname: Gabbar
keywords: Cervical spine fractures; Cervical spine injuries; Lateral cervical spine radiographs; Soft tissue measurements
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