Cervical spine injuries can involve the cervical vertebral column, intervertebral discs and cervical spine ligaments, and/or cervical spinal cord. The cervical spine accounts for ~50% of all spinal injuries. 

Epidemiology

5-10% of patients with blunt trauma have a cervical spine injury ¹. 

Pathology

Patients can have a combination of injuries including:

• atlanto-occipital dissociation
• occipital condyle fracture
• cervical spine fractures
• discoligamentous injury
  • anterior subluxation (posterior ligamentous complex rupture)
• facet joint dislocation
• spinal epidural haematoma
• spinal cord injury
• vertebral artery dissection

Aetiology

• blunt trauma: motor vehicle accident (40%), falls, sports injuries
• penetrating trauma: gun shot injuries, stabbing

Associations

• closed head injury: patients with GCS <8 at highest risk ³

Radiographic features

CT and MRI both have roles to play. CT is used to assess patients who are obtunded, at high-risk, or those unable to be cleared by clinical criteria (e.g. NEXUS criteria, Canadian C-spine rule).

The majority of patients are imaged while being immobilised in a cervical spine collar. If the CT is reported as negative, the collar is typically removed (cervical spine collar clearance). A select few patients nevertheless require further assessment with MRI. 

MRI is used to assess for discoligamentous injury but has a controversial role in patients who are obtunded and a normal CT with some advocating it as unnecessary due to the CT's high negative predictive value for unstable cervical spine injuries ¹.  

Please see the individual articles listed above for further details in imaging findings. 

See also

• cervical spine fracture classification systems