Cervical spine radiographs should be done if one or more of the following are present:
(1) altered sensorium (not alert) at time of examination or history for loss of consciousness
(2) intoxication from drugs and/or alcohol
(3) neurologic impairment (respiratory compromise, motor dysfunction, sensory loss) compatible with a cervical origin
(4) neck pain
(5) cervical tenderness on palpation
Cadoux et al also included:
(6) history of direct cervical trauma and/or high speed motor vehicle accident
Cervical spine radiographs may not be needed if patient has all of the following findings:
(1) alert with no history for loss of consciousness
(2) no drug or alcohol intoxication
(3) no neurological findings compatible with a cervical origin (Hoffman et al specify no focal neurological deficit)
(4) no neck pain (Hoffman et al specify no distracting injury)
(5) no cervical tenderness on palpation (Hoffman et al specify no midline tenderness)
Limitations (Changaris):
• A few fractures may be asymptomatic initially but become evident several days later. A followup examination several days after the injury should be considered.
• A neurosurgeon may be able to identify subtle cervical spine injuries with a careful neurological examination (these might not be associated with a detectable radiologic lesion).
