High-resolution CT scanning in the evaluation of cervical spine fractures: comparison with plain film examinations

Forty-nine patients with cervical spine fractures were identified among 160 patients who underwent CT of the cervical spine for blunt trauma. Although there was a high index of suspicion on the plain film interpretation, as well as a large percentage of false positives, many fractures were found on CT that were not suggested, even in retrospect, on the plain radiographs. Of the 136 fractures ultimately identified in these patients, CT detected 135 (99%) while only 64 (47%) were seen or suspected on the initial screening radiographs. At first glance, this might appear to discredit the plain films as a screening device. However, most of these "occult" fractures occurred in vertebrae that had been identified as probably fractured in other parts, for example, pedicle fractures found in vertebrae initially suspected of harboring only a vertebral body fracture. Most of the remainder of the uncovered fractures were in vertebrae immediately adjacent to ones that were initially identified as fractured. Indeed, of the 49 patients with fractures, only one had an adequately exposed and positioned plain film that was completely normal. The ability of CT to determine quickly and confidently the presence or absence of cervical fractures and to define the position of fragments in relation to the spinal canal is of considerable value in the medical and nursing management of the seriously traumatized patient. For example, when a fracture is seen or suspected on conventional films, a limited CT examination of the area is recommended. Plain films should be used to guide the CT examination so that an intact vertebra above and below the lesion is included. If an adequately exposed and positioned plain film series of the cervical spine is normal, it is unlikely that CT will reveal a fracture. While conventional radiographs fail to detect a surprising number of fractures, they retain their value as a screening tool and as a guide to selective CT imaging.