Radiographic evaluation of cervical spine trauma. Plain radiography and conventional tomography versus computed tomography.

Different imaging modalities are available for the diagnosis of cervical spine injuries. There is a controversial discussion about whether plain radiography (PR), conventional tomography (CTO) or computed tomography (CT) should primarily be used. PR and CTO are more often available and less costly than CT. Especially in second-care hospitals, CT is not always available. The diagnostic work-up in these centres has to rely on conventional techniques. The aim of this study was to define the role of PR supplemented by CTO in the diagnosis of cervical spine trauma in comparison to CT. Twenty-five patients were identified who underwent plain radiography (PR), conventional tomography (CTO) and computed tomography (CT) for the diagnosis of a cervical fracture. In 19 patients a fracture of the cervical spine was identified. All images were reviewed by two independent observers to estimate the interobserver variability. The highest detection rate was achieved by CT (18/18 fractures detected for observer 1/2), followed by CTO (16/16 fractures) and then PR (15/14 fractures). When the detection rates of PR and CTO are combined, 18 fractures were detected by each of the observers. The results were analysed for the dens and the rest of the cervical spine independently. For PR and CTO the detection rates were lower for fractures of the dens than for the rest of the cervical spine. We conclude that the combination of PR and CTO accurately detects fractures of the cervical spine compared with CT. If a fracture of the dens is suspected, the patients should be referred to CT due to its superior accuracy in this region.