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Indian Journal of Neurotrauma 2015; 12(01): 035-040
DOI: 10.1055/s-0035-1554995
Original Article
Neurotrauma Society of India

Diagnosing Cervical Spine Injury in Severe Head Injury: A Case for Replacing Plain Radiography With Computed Tomographic Scan of the Cervical Spine

Shanky Singh
1   Department of General Surgery, Gian Sagar Medical College and Hospital, Banur, Punjab, India
,
Ravi Garg
2   Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
,
Paramjit Singh
3   Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
,
Pravin Salunke
2   Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
,
Sunil Gupta
2   Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
› Author Affiliations
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Further Information

Publication History

12 October 2014

08 December 2014

Publication Date:
11 June 2015 (online)

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Abstract

Introduction The diagnosis and management of cervical spine injuries in head-injured patients is problematic due to an altered level of consciousness and the overall critical nature of their injuries. It is a routine practice in most of the hospitals to get plain radiography for detection of bony spinal injuries which can miss some cases of fractures and fracture dislocations. It is imperative not to miss a cervical spine injury in patients with severe head injury. The aim of our study was to find which modality offers the greatest accuracy as the initial diagnostic test among patients suspected of having sustained a cervical spine surgery following severe head injury: plain radiography or computed tomography (CT) of cervical spine.

Patients and Methods This is a prospective study conducted on patients with severe head injury. In this study, 50 patients with severe head injuries were investigated by both plain X-rays and CT scan of the cervical spine. In these patients, the level and type of cervical spine injury were compared between plain X-ray and CT scan.

Results Plain X-rays detected cervical spine injury in 20%, while CT scan demonstrated spinal injury in 26% of the patients. Four patients of cervical spine fracture missed by plain radiography were diagnosed by CT cervical spine. In one patient in whom plain radiography showed fracture-dislocation at C5—C6 level was found to have degenerative changes at that level. C6—C7 was the most common site of fracture-dislocation (40.0%) followed by C5—C6 (20.0%), C4—C5 (20.0%), and C3—C4 (10.0%). C2 is the most common site of fracture diagnosed by CT scan which was missed by plain radiograph.

Conclusion It was concluded that it would be prudent to replace the practice of routine plain radiography with routine use of CT scans for detection of spinal bony injuries.

Keywords

severe head injury - cervical spine injury - CT scan
 

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