Radiographic evaluation of cervical spine trauma - Plain radiography and conventional tomography versus computed tomography

Different imaging modalities are available for the diagnosis of cervical sp ine injuries. There is a controversial discussion about whether plain radio graphy (PR), conventional tomography (CTO) or computed tomography (CT) shou ld primarily be used. PR and CTO are more often available and less costly t han CT. Especially in second-care hospitals, CT is not always available. Th e diagnostic work-up in these centres has to rely on conventional technique s. The aim of this study was to define the role of PR supplemented by CTO i n the diagnosis of cervical spine trauma in comparison to CT. Twenty-five p atients were identified who underwent plain radiography (PR), conventional tomography (CTO) and computed tomography (CT) for the diagnosis of a cervic al fracture. In 19 patients a fracture of the cervical spine was identified . All images were reviewed by two independent observers to estimate the int erobserver variability. The highest detection rate was achieved by CT (18/1 8 fractures detected for observer 1/2), followed by CTO (16/16 fractures) a nd then PR (15/14 fractures). When the detection rates of PR and CTO are co mbined, 18 fractures were detected by each of the observers. The results we re analysed for the dens and the rest of the cervical spine independently. For PR and CTO the detection rates were lower for fractures of the dens tha n for the rest of the cervical spine. We conclude that the combination of P R and CTO accurately detects fractures of the cervical spine compared with CT. If a fracture of the dens is suspected, the patients should be referred to CT due to its superior accuracy in this region.