Radiography versus spiral CT in the evaluation of cervicothoracic junction injuries in polytrauma patients who have undergone intubation.

A prospective study was performed over a 1-year period in patients who had sustained blunt trauma, mostly in motor vehicle accidents. All 73 patients (56 male and 17 female; age range, 2-94 years; mean age, 35.2 years) in the study had undergone intubation and ventilation at the trauma site (mean Glasgow Coma Score, 9.9 [range, 3-15]; mean Injury Severity Score, 30.4 [range, 8-75]) and subsequently underwent three-view radiography of the cervical spine and thin-section spiral computed tomography (CT) of the cervicothoracic junction. Spinal fractures were detected in 20 patients and involved the cervicothoracic junction region in 12 cases. In all 12 patients, the fractures were visualized at CT, whereas in seven of 12 patients, conventional radiography failed to demonstrate injuries (transverse process fracture of T1 [n = 1], pedicle and vertebral body fracture of C7 [n = 1], fractures of the first and second ribs [n = 5]). Thus, routine CT of the cervicothoracic junction in a highly select group of severely injured patients helped detect occult fracture in seven of 73 patients (10%); however, most of these fractures were not clinically significant. Larger studies involving a high-risk patient population are needed to confirm these findings.