1.

Aim of imaging

The main aim of imaging is to avoid preventable neurological

deterioration and to aid short and long term management of spinal

injury. Significant spinal injuries have been missed in 4.6–10.5% of

patients in a number of studies (Fig. 1).IFF]T[9_D$D1–4 This has led to avoidable

ABSTRACT

Traumatic spine injuries _]FFID$DT[3can be devastating for patients affected and for health care professionals F]FID$DT_4[if preventable neurological
deterioration occurs. This review discusses the imaging options for the diagnosis of spinal trauma. $[5_TD]FFIDIt lays out when imaging is appropriate and
when it is not. $[5_TDDIFF]It discusses strength and weakness of available imaging modalities. D]FF$I[6_TDAdvanced techniques for spinal injury imaging
will be explored. DT_7[ID$F]FThe review concludes with a review of imaging protocols adjusted to clinical circumstances.
neurological deterioration in about 3% of all patients.

5
Preventable neurological deterioration in the short term may be

caused by treatable cord (or other neural structure) compression

by haematoma, disc herniation or possibly mechanical compres-

instability.
Ideally imaging should also predict long-term neurological and

mechanical stability.
Therefore we are looking for imaging modalities which identify

mechanical instability in the short and the long term and neural compromise in the short and the long term.

At the same time the imaging approach has to allow for rapid and effective clinical decision making and care, be cost effective and ideally
do no harm, or more realistically, do as little harm as possible and justifiable.

E-mail address: Bernhard.tins@rjah.nhs.uk (B.J. Tins).

http://dx.doi.org/10.1016/j.jcot.2017.06.012

0976-5662/© 2017

sion by bone or by vascular compromise.

Mechanical compression may also be due to mechanical

spine rule (CCR) study. Both these studies have looked at patients with suspected neck injuries.

7–14
None of these is trivial and without clinical impact. It is

therefore desirable to identify patients who do not need to undergo imaging examinations of their spine after trauma.

15,16
In particular 2 studies have come to the fore trying to address this issue, the US American NEXUS study and the Canadian C-

17,18

The NEXUS rules are inferior to the Canadian C-spine rule in sensitivity and specificity and result in a higher imaging rate than the CCR
but apply to all ages while the CCR only applies to the ages 16–65 years. Both these rules are only applicable to fully alert patients with a
Glasgow Coma scale (GCS) of 15.

The NEXUS criteria are as follows: if there is

no tenderness at the posterior cervical spine midline
no focal neurological deficit
normal level of alertness
no evidence of intoxication
no painful injury that might distract from the pain of a cervical

spine injury
then the cervical spine can be seen as cleared.