Unstable C-spine injury with normal C-spine radiographs.

There is some controversy surrounding the optimal mode of imaging in trauma patients with suspected cervical (C) spine injury. Various rules (most notably the Canadian C-spine rules and the NEXUS rules) have been designed to help reduce the need for imaging given the poor yield. Some authorities advocate CT for almost all cases whereas others advocate three view radiographs unless the patient is at high risk, in which case CT is the preferred choice. One meta-analysis showed sensitivity of 58% (39-76%) for plain radiographs and 98% for CT in identification of C-spine injuries following blunt trauma. This case report illustrates how very unstable C-spine injuries may not be apparent on plain radiographs and a degree of clinical suspicion may be required for further imaging. 2014 BMJ Publishing Group Ltd.