 Introduction/Background Cervical Spine Imaging An estimated 3% to 4% of patients presenting to the emergency department with blunt trauma have sustained an injury to the cervical spine [1,2]. Cervical spine injuries can range from stable minor soft-tissue injuries to unstable complex injury patterns resulting in complete disruption of the cervical spine with possible neurologic or vascular injury. The wide spectrum of injury patterns can make the decision process for when to perform imaging and what type of imaging to perform challenging. Overutilization of MRI and CT imaging of the cervical spine can result in an extended emergency center visit while awaiting imaging as well as iatrogenic injuries related to prolonged cervical collar placement [3], exposure to intravenous (IV) contrast, and exposure to radiation and high-power magnetic fields. On the other hand, failure to identify an unstable cervical spine or cervical vascular injury can result in poor clinical outcomes. The National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Rules (CCR) are well-established clinical criteria for exclusion of clinically significant cervical spine injury. In their original application of the NEXUS criteria, Hoffman et al [4] found the NEXUS criteria to have a 99.6% sensitivity for detecting clinically significant cervical injury. The CCR criteria has a similar sensitivity for identifying cervical spine injury with the initial study by Stiell et al [5] that applied the CCR criteria identifying 100% of clinically significant cervical spine injuries. Since their inception, a few studies have directly compared the CCR and NEXUS criteria and have found the CCR to slightly outperform NEXUS in selecting patients at risk for cervical spine injury [6,7]. However, multiple studies have validated the sensitivity of both the NEXUS and CCR criteria for identifying clinically significant cervical spine injuries [7-12].
Suspected Spine Trauma PCAs.  Introduction/Background Cervical Spine Imaging An estimated 3% to 4% of patients presenting to the emergency department with blunt trauma have sustained an injury to the cervical spine [1,2]. Cervical spine injuries can range from stable minor soft-tissue injuries to unstable complex injury patterns resulting in complete disruption of the cervical spine with possible neurologic or vascular injury. The wide spectrum of injury patterns can make the decision process for when to perform imaging and what type of imaging to perform challenging. Overutilization of MRI and CT imaging of the cervical spine can result in an extended emergency center visit while awaiting imaging as well as iatrogenic injuries related to prolonged cervical collar placement [3], exposure to intravenous (IV) contrast, and exposure to radiation and high-power magnetic fields. On the other hand, failure to identify an unstable cervical spine or cervical vascular injury can result in poor clinical outcomes. The National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian Cervical Rules (CCR) are well-established clinical criteria for exclusion of clinically significant cervical spine injury. In their original application of the NEXUS criteria, Hoffman et al [4] found the NEXUS criteria to have a 99.6% sensitivity for detecting clinically significant cervical injury. The CCR criteria has a similar sensitivity for identifying cervical spine injury with the initial study by Stiell et al [5] that applied the CCR criteria identifying 100% of clinically significant cervical spine injuries. Since their inception, a few studies have directly compared the CCR and NEXUS criteria and have found the CCR to slightly outperform NEXUS in selecting patients at risk for cervical spine injury [6,7]. However, multiple studies have validated the sensitivity of both the NEXUS and CCR criteria for identifying clinically significant cervical spine injuries [7-12].