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Endgames Picture Quiz

Imaging after trauma to the neck

BMJ 2008; 337 doi: (Published 03 September 2008) Cite this as: BMJ 2008;337:a207
  1. Bernard Wee, specialist registrar1,
  2. John H Reynolds, consultant radiologist1,
  3. Anthony Bleetman, consultant emergency medicine2
  1. 1Department of Radiology, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham B9 5SS
  2. 2Department of Emergency Medicine, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital
  1. john.reynolds{at}

    Case history

    A patient was brought by ambulance to the emergency department several hours after falling down a flight of steps. She was delivered on a spinal board with her neck immobilised in a collar, blocks, and tape. She complained of severe neck pain but was otherwise alert and orientated. Her score on the Glasgow coma scale was 15. No abnormal neurological findings were present on examination and the rest of the examination was unremarkable. Given the history of a high risk mechanism and severe neck pain, screening cervical radiographs were obtained.


    • 1. What are the standard views in a cervical spine trauma series?

    • 2. What lines are used to evaluate a lateral cervical spine radiograph?

    • 3. What abnormalities do these radiographs show?

    • 4. What is the clinical significance of this injury?

    • 5. What further imaging does this patient need?


    Short answers

    • 1. Anteroposterior lateral and anteroposterior odontoid peg views.

    • 2. Anterior spinal line, posterior spinal line, spino-laminar line, posterior pillar line, and spinous process line.

    • 3. There is bilateral facet joint subluxation with splaying of the spinous processes.

    • 4. This injury is an unstable injury.

    • 5. Computed tomogram and magnetic resonance image of the cervical spine.

    Long answers

    1. Standard views

    According to the National Institute for Health and Clinical Excellence 1, the standard trauma series consists of three views—namely, anteroposterior, lateral, and anteroposterior odontoid peg views. The two large …

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