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.
5-10% of patients with blunt trauma have a cervical spine injury 1.
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 hematoma
- spinal cord injury
- vertebral artery dissection
- blunt trauma: motor vehicle accident (40%), falls, sports injuries
- penetrating trauma: gun shot injuries, stabbing
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 immobilized 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 individual articles listed above for further details in imaging findings.
- 1. Dreizin D, Letzing M, Sliker CW et-al. Multidetector CT of blunt cervical spine trauma in adults. Radiographics. 2014;34 (7): 1842-65. doi:10.1148/rg.347130094 - Pubmed citation
- 2. Parizel PM, van der Zijden T, Gaudino S et-al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J. 2010;19 Suppl 1 (S1): S8-17. doi:10.1007/s00586-009-1123-5 - Free text at pubmed - Pubmed citation
- 3. Holly LT, Kelly DF, Counelis GJ et-al. Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. J. Neurosurg. 2002;96 (3 Suppl): 285-91. Pubmed citation
- 4. Thompson WL, Stiell IG, Clement CM et-al. Association of injury mechanism with the risk of cervical spine fractures. CJEM. 2009;11 (1): 14-22. Pubmed citation