A 25-year-old female patient is being assessed for a possible cervical spine injury following blunt trauma. Her C-spine X-ray series is inadequate and a decision is made to organise a CT scan of her cervical spine.
- Under what circumstances should CT scanning be used as the primary modality for excluding cervical spin injury in Trauma?
CT should be used as the primary imaging modality for excluding cervical spine injury in adults following blunt trauma if any of the following criteria are met:
- GCS below 13 on initial assessment (level two evidence)
- Intubated patients (level two evidence)
- Inadequate plain film series (level two evidence)
- Suspicion or certainty of abnormality on plain film series (level two evidence)
- Patient’s being scanned for head injury or multi-region trauma (level two evidence)
- Patient has dementia (or a chronic disability precluding accurate clinical assessment) (level five evidence)
- Patient has new neurological signs or symptoms (level two evidence)
- Patient has severe neck pain (≥7/10 severity) (level four evidence)
- Patient has a significantly reduced range of neck movement (level four evidence)
- Patients with known vertebral disease (e.g. ankylosing spondylitis, rheumatoid arthritis, spinal stenosis, or previous cervical surgery) (level four evidence)
- As a minimum, which anatomical area should her CT scan cover?
As a minimum the CT should cover the area from the cranio-cervical junction to the thoraco-cervical junction.
- When is MRI of the cervical spine indicated in an adult following blunt trauma?
An MRI is indicated if there are any of the following:
- Neurological signs and symptoms referable to the cervical spine
- Suspicion of vertebral artery injury
- Severely restricted neck movement or severe pain (≥7/10) despite a normal CT
It should be noted that MRI should always be used in conjunction with another imaging modality, preferably CT, in order not to miss bony injuries.
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