FREQUENCY AND SIGNIFICANCE OF FRACTURES OF THE UPPER CERVICAL-SPINE DETECTED BY CT IN PATIENTS WITH SEVERE NECK TRAUMA

OBJECTIVE. Radiographic evaluation of the upper cervical spine in patients who have suffered severe trauma is often problematic because of the difficulty of obtaining adequate open-mouth views of the odontoid in these critically ill patients. This study was undertaken to determine the frequency and clinical significance of upper cervical spine fractures detected by CT in this patient population. MATERIALS AND METHODS. The study group consisted of 100 consecutive patients brought to the emergency department after severe trauma who had CT of the craniocervical junction done instead of an open-mouth view. Plain film evaluation consisted of a cross-table lateral view, an anteroposterior view, and, if necessary, a swimmer's view. The radiographic studies were reviewed retrospectively by a musculoskeletal radiologist and a neuroradiologist, respectively. Hospital records were reviewed to ascertain the patients' clinical signs and symptoms on admittance and to determine how identification of the fractures changed the treatment plan. RESULTS, Eight fractures in seven patients were identified with CT of the craniocervical junction. Three of the fractures were of the occipital condyle, and five were at the C1-C2 level. None of the fractures were seen directly on plain radiographs, although secondary signs of injury such as prevertebral soft-tissue swelling were seen in two of the seven cases. CONCLUSION. CT of the craniocervical junction revealed an 8% frequency of fractures of the occipital condyle and C1-C2 that were undetected on the cross-table lateral cervical spine radiographs. Fractures occurred in greater numbers than expected, and all surviving patients were stabilized with a halo. This experience shows that CT is an efficient method of evaluating patients in whom the standard open-mouth radiograph of the odontoid cannot be done.