PT 636 Radiologic Evaluation of the Cervical Spine

what are the basic projections for the entire cervical spine

- AP

- lateral view

what are the additional projections for the entire cervical spine

- open mouth AP (odontoid view)

- swimmer's lateral (lower cervical, CT junction)

- cross-table lateral suspected cervical fracture

- bilateral oblique - assessment of neural foramina

- flexion-extension lateral view - suspected instability

- articular (pillar) view - suspected facet fracture

what is the NEXUS criteria for cervical spine imaging

- focal neurologic deficit

- midline spinal tenderness

- altered level of consciousness

- intoxication

- distracting injury

what is the sensitivity and specificity of the NEXUS criteria

- high sensitivity and low specificity

the ________ has a high sensitivity and negative predictive value for identifying significant cervical injury

NEXUS

what are the high risk factors that mandates an X-ray

- age >65

- paresthesias in extremities

- dangerous mechanisms

what are the dangerous mechanisms

- falls from >3 feet/5 stairs

- axial load to head

- motor vehicle crash with high speed, rollover or ejection

- bicycle collision

- motorized recreational vehicle accident

what is the low risk factors that allow safe assessment of ROM and if present warrant no x-ray

- simple rear-end motor vehicle crash

- patient in sitting position in emergency center

- patient ambulatory at any time after trauma

- delayed onset of neck pain

- absence of midline cervical spine tenderness

if a patient has low-risk factors and cannot rotate their head 45 degrees what is the next step

x-ray

what is the sensitivity and specificity for canadian cervical spine rules

- 100% sensitivity and 43% specificity

what is the initial imaging for neck pain only

- consider red flags

- if present x-ray

- if not present conservative treatment

what is the initial imaging for radiculopathy

- conservative treatment if not improved MRI

what is the initial imaging for a possible cord compression

- MRI

what is the initial imaging for possible spinal stenosis

- if imaging indicated MRI

if the cause for neck pain is uncertain after x-ray what is the next imaging

- MRI

if there is a suspected infection or abscess what is the next imaging

- MRI

what is the ACR criteria for atraumatic neck pain

- radiograph maybe first

- if no gains and/or degenerative changes MRI

what are the red flags for headache

- thunderclap headache

- progressively worsening headache

- new headache in the older population

- new onset headache in a a patient with a history of cancer or immunodeficiency syndrome

- headache with mental state changes

- headache with fever/neck stiffness/meningeal signs

- headache with focal neurological deficit if not previously recognised in the context of a migrainous aura

- headache causing wakening from sleep

- headache in a patient with recent ingestion of amphetamine/cocaine

- headache in pregnancy/post-partum

- headache worsened by valsalva

- significant trauma

- history of seizures in non-epileptic

- headache different than usual migraine