A 25-year-old female patient is being assessed for a possible cervical spine injury following blunt trauma. Her C-spine X-ray series is inadequate and a decision is made to organise a CT scan of her cervical spine.
- Under what circumstances should CT scanning be used as the primary modality for excluding cervical spin injury in Trauma?
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CT should be used as the primary imaging modality for excluding cervical spine injury in adults following blunt trauma if any of the following criteria are met:
- GCS below 13 on initial assessment (level two evidence)
- Intubated patients (level two evidence)
- Inadequate plain film series (level two evidence)
- Suspicion or certainty of abnormality on plain film series (level two evidence)
- Patient’s being scanned for head injury or multi-region trauma (level two evidence)
- Patient has dementia (or a chronic disability precluding accurate clinical assessment) (level five evidence)
- Patient has new neurological signs or symptoms (level two evidence)
- Patient has severe neck pain (≥7/10 severity) (level four evidence)
- Patient has a significantly reduced range of neck movement (level four evidence)
- Patients with known vertebral disease (e.g. ankylosing spondylitis, rheumatoid arthritis, spinal stenosis, or previous cervical surgery) (level four evidence)
- As a minimum, which anatomical area should her CT scan cover?
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As a minimum the CT should cover the area from the cranio-cervical junction to the thoraco-cervical junction.
- When is MRI of the cervical spine indicated in an adult following blunt trauma?
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An MRI is indicated if there are any of the following:
- Neurological signs and symptoms referable to the cervical spine
- Suspicion of vertebral artery injury
- Severely restricted neck movement or severe pain (≥7/10) despite a normal CT
It should be noted that MRI should always be used in conjunction with another imaging modality, preferably CT, in order not to miss bony injuries.
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