Treatment of Cervical Spine Injury Based on the Angular Deformity Seen on a Lateral Cervical X-ray

The angular deformity seen on a lateral X-ray can be used to determine the therapeutic approach following cervical spine injury.

Patient selection: cervical spine injury

Examination: lateral cervical X-ray

Treatment options:

(1) rigid collar

(2) Minerva/halo

(3) surgical fusion

Parameters:

(1) relative angulation of the cervical spine in the lateral X-ray

(2) neurologic findings

(3) flexion-extension radiograph

Relative Angulation	Neurologic Findings	Flexion-Extension Radiograph	Treatment Options
< 7 degrees	NA	< 7 degrees (*)	rigid collar
< 7 degrees	NA	7 - 11 degrees (*)	Minerva/halo
< 7 degrees	NA	> 11 degrees (*)	surgical fusion
7 - 11 degrees	intact	<= 11 degrees	Minerva/halo
7 - 11 degrees	intact	> 11 degrees	surgical fusion
7 - 11 degrees	deficit	NA	surgical fusion
> 11 degrees	NA	NA	surgical fusion

(*) Measured after wearing a rigid collar for 1 week.

Surgical fusion is done with one or more of the following:

(1) neurologic deficit present

(2) relative angulation > 11 degrees

(3) flexion-extension radiograph > 11 degrees

Minerva/halo is used if:

(1) relative angulation 7-11 degrees and neurologically intact

(2) flexion-extension radiograph 7-11 degrees and neurologically intact

Else continue with the rigid collar.

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