Abstract
The frequency of cervical injuries varies with the trauma violence (3 to 30 %) and increases with age. Because clinical signs are often misleading, radiological evaluation must frequently be performed. A strategy based on clinical signs, traumatic causes, and age can allow a reasoned choice of cervical spine imaging according to the determination of fracture risk. Some patients with no midline cervical tenderness, no focal neurological deficit, normal alertness, not intoxicated, and not painful with no distracting injury do not need radiological examination. In the other cases, cervical spine imaging is essential. We have the choice to perform standard radiographs or helical CT-scan. CT-scan has a better sensibility than standard radiographs to detect cervical fractures or luxations and allows to explore the cervical spine lesions difficult to see (hinges). CT scan is necessary in first intention among patients at high risk of cervical lesions : unconscious traumatized patients, severe cerebral lesions on the CT-scan, multiple trauma, high energy traumatism with age older than 50. RMN is necessary in second time in case of medullar irritation with normal CT-scan or if a vascular or disco-ligamentary lesion is suspected. The diagnosis of ligamentar instability can justify dynamic radiographs, at distance of traumatism.
Published Version
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