Arteriography Cervicocerebral There is no role for arteriography in assessment of obtunded patients without traumatic injury identified on CT in the absence of clinical findings concerning for cervical vascular injury. Variant 7: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest ligamentous injury. Next imaging study after CT cervical spine without IV contrast. Radiography Cervical Spine The literature has been uniformly negative in assessing the utility of static flexion-extension radiographs or dynamic fluoroscopy for detection of cervical spine ligamentous injuries [32-35,81]. Studies have reported anywhere from 28% to 97% of flexion-extension studies are inadequate for evaluating ligament injury [33-35,82]. Even when flexion-extension radiographs are technically adequate, they rarely demonstrate evidence of ligament instability [32,34,76,81], and positive studies rarely result in significant change in clinical management [32,33,76,81]. The low rate of technically adequate studies along with the low sensitivity and specificity of Suspected Spine Trauma flexion-extension radiographs makes this study undesirable for assessment of cervical spine ligament injuries. Furthermore, flexion-extension radiographs carry the real danger of producing neurologic injury. Flexion- extension radiographs fail to reveal most ligament injuries identified on MRI and can result in increased length of cervical immobilization [74,75]. In the very limited circumstance where MRI findings are equivocal for ligamentous injury, flexion-extension radiographs may be useful to determine whether the MRI findings correlate with pathologic motion. MRI has a high sensitivity for cervical ligament injury and identifies many ligament injuries that are clinically insignificant [42,62]. Flexion-extension radiographs are most appropriate when MRI has demonstrated abnormal signal in spinal ligaments without definite disruption.
Suspected Spine Trauma PCAs. Arteriography Cervicocerebral There is no role for arteriography in assessment of obtunded patients without traumatic injury identified on CT in the absence of clinical findings concerning for cervical vascular injury. Variant 7: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical or imaging findings suggest ligamentous injury. Next imaging study after CT cervical spine without IV contrast. Radiography Cervical Spine The literature has been uniformly negative in assessing the utility of static flexion-extension radiographs or dynamic fluoroscopy for detection of cervical spine ligamentous injuries [32-35,81]. Studies have reported anywhere from 28% to 97% of flexion-extension studies are inadequate for evaluating ligament injury [33-35,82]. Even when flexion-extension radiographs are technically adequate, they rarely demonstrate evidence of ligament instability [32,34,76,81], and positive studies rarely result in significant change in clinical management [32,33,76,81]. The low rate of technically adequate studies along with the low sensitivity and specificity of Suspected Spine Trauma flexion-extension radiographs makes this study undesirable for assessment of cervical spine ligament injuries. Furthermore, flexion-extension radiographs carry the real danger of producing neurologic injury. Flexion- extension radiographs fail to reveal most ligament injuries identified on MRI and can result in increased length of cervical immobilization [74,75]. In the very limited circumstance where MRI findings are equivocal for ligamentous injury, flexion-extension radiographs may be useful to determine whether the MRI findings correlate with pathologic motion. MRI has a high sensitivity for cervical ligament injury and identifies many ligament injuries that are clinically insignificant [42,62]. Flexion-extension radiographs are most appropriate when MRI has demonstrated abnormal signal in spinal ligaments without definite disruption.