Cervical Spine Trauma
When to X-ray
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High Energy Multiple Injury
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Head Injury with neck pain
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Hyperflexion / extension Injury with neck tenderness (over midline)
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?? drunk/uncooperative patients
Which X-rays?
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Lateral
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AP
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Open mouth (odontoid peg) views
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+/- Oblique views
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+/- Flexion extension views to diagnose instability
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+/- C T Scan
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+/- MR scan
Sensitivity of Lateral C spine X-ray alone is 70-85%
Sensitivity of 3 series- (AP, lateral and open mouth views) is 80-95%
Sensitivity if CT added is 95-100%
If a cervical spine fracture is found:
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50% have a fracture at an adjacent level
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15% have a fracture in another part of the cervical spine
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10% Have fractures in thoracic/ lumbar spine
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