Imaging of cervical spine trauma: are the anteroposterior and odontoid radiographs needed when CT of the entire cervical spine is routine?

Abstract

Objective: To evaluate the contribution of the anteroposterior (AP) and odontoid radiographs in cervical spine trauma when helical CT of the entire cervical spine is performed in routine screening. Methods: In part 1 of the study, 47 patients with cervical spine fracture (positive) and 92 patients without fracture (negative) were retrospectively assembled into a study population. For each patient, the lateral radiograph and the CT were evaluated for the presence or absence of fracture. The results were compared to the radiology report at the time of injury which was based on the lateral, AP, and odontoid radiographs plus the CT (gold standard). In part 2 of the study, the individual sensitivities of CT and each radiograph were determined by review of the 47 positive patients with the fracture locations known a priori. Results: In all 47 positive patients, the presence of fracture was correctly identified using only the lateral radiograph and the CT. In none of the 92 negative patients was the lateral radiograph plus CT incorrectly interpreted as positive for fracture. The sensitivities for fracture of CT, the lateral radiograph, the AP radiograph, and the odontoid radiograph were 100, 47, 28, and 18 % respectively. Conclusion: The AP and odontoid radiographs did not contribute to the evaluation of suspected cervical spine fracture when the lateral radiograph and helical CT of the entire cervical spine were performed in routine screening.