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Essential Knowledge for Proper Patient Management: Diagnosing Subtle Post-Traumatic Abnormalities of the Cervical Spine 2013

Category General Spine Phillip Fairbourn, MD
Amar Amin, MD
Daniel Gridley, MD
Purpose Devastating clinical consequences arise when cervical spinal injuries remain undiagnosed (AJR 2000: 175: 661-665). Ligamentous injury occurs in 4.2% of blunt trauma cases and 10% of trauma cases involving the head. Given the high incidence, a systematic radiographic approach is vital to ensure rapid and accurate identification of injury in the cervical spine. The purpose of this presentation is to allow the radiologist to develop a simple approach to identify and diagnose potentially life threatening ligamentous cervical spinal and soft tissue injuries. This will be achieved by demonstrating a straightforward technique for a swift and complete diagnosis of injury.  This exhibit will teach the identification of subtle injuries frequently found in a trauma setting and illustrate a systematic evaluation of the cervical spine in an easy step-by-step approach. Materials & Methods The imaging modalities utilized include magnetic resonance imaging, computed tomography and plain film radiography: including flexion, extension and fluoroscopic views. Using these modalities, we review the cervical anatomy, then further explore the mechanism of injury and type of traumatic insult. Cervical spinal lines, prevertebral soft tissue spaces, disc spaces, facet articulations and the spinal cord are all employed to achieve this understanding. Injury types examined include interspinous ligamentous injury; posterior and anterior longitudinal ligamentous rupture, especially in patients with history of degenerative spine disease and arthropathies; and craniocervical junction injures in patients with underlying rheumatoid arthritis/pannus formation and Down’s syndrome. Results Clinical cases are used to demonstrate the developed search and evaluation patterns, which enables a radiologist to more consistently and accurately diagnose a cervical spinal injury, thereby ensuring proper treatment and improving patient outcome. Conclusion Evaluation of the cervical spine in the trauma setting need not be a daunting task. By applying knowledge of cervical spine anatomy and abnormailites, and employing an organized search pattern, a radiologist will better be able to make an accurate diagnosis of cervical spinal injury. References Benedetti PF, Fahr LM, Kuhns LR, et al. MR Imaging Findings in Spinal Ligamentous Injury. American Journal of Roetgenology 2000: 661-665.