a) Lateral cervical spine plain X ray
- In the unstable non-responder with devastating injuries and GCS=3, who shows no evidence of extremity movement and for whom emergent transfer to surgery without CT imaging is being considered, a cross-table lateral c-spine may demonstrate atlanto-occipital dislocation or other severely displaced c-spine fracture, which portends a poor prognosis and thereby facilitates a decision not to proceed to surgery.
- A major c-spine fracture dislocation identified in this manner indicates a particularly poor prognosis in the severely head injured and/or elderly patient.
b) Cervical spine series radiographs
- Not indicated in the severely injured patient
- If radiography ordered based on Canadian c-spine rule (Appendix G) then minimum views needed:
- lateral to include C7-T1
- Open mouth odontoid
- Obliques not necessary
c) Standard trauma imaging CT protocol
- The basic set of of CT imaging that will most often be used an should be considered the starting point for CT imaging of the severely injured patient
- Includes cervical spine (non-contrast)
- See Appendix C for criteria for the ordering of this standard CT protocol
- A normal CT is adequate to clear the cervical spine injury if:
- CT of c-spine is normal, and
- Patient is accessible neurologically (i.e., moves all four limbs), and
- There is no clinical suspicion of cord injury
If one or more of these conditions are not met, a neurosurgical consult for possible MRI of the c-spine should be considered.
- Abnormal CT of the c-spine can include:
- Significant degenerative changes
- Suspected ligamentous injury
- Conduct CT c-spine if there is a head injury or in elderly patients with GCS<15