Practice ABC of Emergency Radiology, 3rd Edition

Cervical Spine

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2177 (Published 21 August 2014) Cite this as: BMJ 2014;348:bmj.g2177
  1. Leonard J. King
  1. Southampton University Hospitals Southampton, UK

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Overview

  • Most cervical spine injuries are relatively minor, but they can be potentially devastating, requiring prompt diagnosis and stabilisation

  • Cervical spine radiographs are difficult to interpret and 20% of fractures may not be visible. Therefore, there should be a low threshold to proceed to CT

  • CT is now the imaging modality of choice in major trauma

  • MRI is indicated if there is suspicion of neurological, ligamentous or disc injury

Injuries to the cervical spine can occur either in isolation or in association with head injury or multisystem injury following major trauma. Most of these injuries are relatively minor, but they can be potentially devastating, requiring prompt diagnosis and stabilisation to minimise the risk and severity of associated neurological injury. The pattern, frequency and distribution of these injuries vary between different populations. In adults, the C1–2 and C5–6 levels are most typically affected. In children, injuries are less common and usually involve the upper cervical spine.

Up to 40% of cervical spine injuries are associated with neurological injury, with 5–10% reported as the result of missed injury and consequent lack of cervical stabilisation. About 0.1% of cervical spinal cord injuries do not present with a radiographic abnormality. These spinal cord injuries without radiographic abnormality (SCIWORA) most typically affect children and young adults but also occur in older patients, often with associated cervical spine degenerative disease.

Anatomy

The cervical spine (Figure 1) is comprised of seven bony segments, separated by intervertebral fibrocartilaginous discs and supporting ligaments. The third to seventh vertebrae are morphologically similar, …

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