Computed tomography in the initial evaluation of the cervical spine.

Unstable injury of the cervical spine must be considered in all victims of blunt trauma. To evaluate the role of limited, directed computed tomography (CT) in the initial evaluation of the cervical spine, a one-year study involving 104 high-risk patients was undertaken. Sensitivity was 0.78 overall, but in the group of patients scanned after inadequate plain radiographs, CT had a sensitivity of 1.0 for unstable cervical injury. All false-negative studies involved atlantoaxial rotary subluxation. We conclude that limited, directed CT of the cervical spine is appropriate in the initial evaluation of patients at risk, particularly if plain radiographs are inadequate, but is of limited value in the evaluation of ligamentous injury of the upper cervical spine.