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CERVICAL SPINE X RAY FULL
CERVICAL SPINE X RAY SERIES

These are literature based reviews but if you want to do something more because no matter what the literature says, you think there’s a fracture and you want a CT. Once you know this approach, it’s quite straightforward to look after these patients.

patients with minor midline neck pain that meet all other NEXUS criteria.

So the only people that really get plain X-rays are: If they don’t meet the criteria, or if they have significant C-spine tenderness, then they will also need a CT. If the patient is concious and meets all NEXUS criteria, you can clear the C-spine clinically. If the patient is unconscious, you need the CT, but still can’t clear the C-spine. “Then Dr Radiologist, given that the pain is significant, I will need to do a CT if the X-ray is normal or abnormal, so why don’t we just go ahead and do the CT?” If the X-ray is abnormal, I’ll need a CT, won’t I?” “OK then, please help me out Dr Radiologist. If the plain X-ray is normal, I can’t clear the C-spine because the pain is significant and will need a CT, yes?”

CERVICAL SPINE X RAY SERIES

“OK, I’m happy to do a plain series Dr Radiologist, but can I ask you to help me a little with my reasoning. The radiologist may ask if a plain X-ray can be done first. If the neck pain is significant, then that patient will require a CT of the cervical spine. WHAT IF THERE IS SIGNIFICANT MIDLINE NECK PAIN? If there is limitation through pain, the collar stays on. If this is normal, I will remove the collar and test the patient for any limitation of movement, by asking them to turn their head from side to side. If the neck pain is minor and there is no distracting injury and all other nexus criteria apply, then I do a plain 3 series X-ray.

Has there has been a significant mechanism of injury?.

In 10% of cases, there is a second fracture in the spine. What if you do find a fracture in the cervical spine? Then you need to look for another spinal fracture. So beware, if they are unconscious with no evidence of fracture on the CT, we still can’t clear the C-spine. These patients may be required to have an MRI as well.

CERVICAL SPINE X RAY FULL

They can be placed in an ‘aspen’ collar, with full spinal precautions and Neurosurgery at your hospital or the nearest centre, (if in a rural centre) needs to be consulted. If there is no fracture, it doesn’t mean the spine is cleared. Try as we might, it is difficult to clear the cervical spine of the unconscious patient.Ĭertainly these patients require a CT cervical spine at the same time as a head CT. The UNCONSCIOUS and the CONSCIOUS patient. In order to clear the spine completely, we need to have an awake and alert patient, that we can question about cervical spine pain and that we can examine to ensure that they are neurologically intact. Cervical fracture was excluded, but ligamentus injury and cord injury were not. He responded that there were no fractures on the CT cervical spine. I stopped him, unsure of what was happenning. The child was intubated with in-line immobilization and stabilized, then had a pan scan.įollowing review of the CT scan, a senior doctor, proceeded to remove the cervical hard collar. Cervical spine precaustions were in place.

There was a closed head injury of significance and the GCS was 4. A Recent CaseĪn 8 year old child was brought into the emergency department following being involved in a motor vehicle accident.

Once we understand the basics, clearance of the cervical spine is not a mystery.

The cervical spine continues to cause problems.