Send to

Choose Destination
Emerg Radiol. 2019 Apr;26(2):133-138. doi: 10.1007/s10140-018-1652-5. Epub 2018 Nov 1.

What is the added sensitivity of non-lateral cervical spine radiographs in the evaluation of acute cervical spine trauma?

Author information

Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1001 Potrero Ave, Room 1X57, SFGH, Box 1325, San Francisco, CA, 94110, USA.
Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA, 94305, USA.
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, 333 Cedar St, P.O. Box 208042, New Haven, CT, 06520-8042, USA.



Plain radiography of the cervical spine is used as a screening test for trauma patients. We evaluated the diagnostic yield of performing anteroposterior (AP), odontoid, and oblique views in addition to the lateral view in the current era when radiographs are performed only on low-risk patients.


All imaging reports from cervical spine radiography studies on patients aged 18 years and older in the emergency room of a major academic medical center between November 22, 2003, and January 17, 2012, were retrospectively reviewed. For the clinical workflow employed at the time of study acquisition, radiologists prospectively reviewed the lateral projection and subsequently reviewed the entirety of the images obtained. Exam reports and, when necessary, images were reviewed to determine which patients had fractures and on which projection the fractures were identified.


Six fractures were detected in 7218 exams. Three of these fractures were identified on the lateral radiograph, and three of these fractures were visualized on the additional projections (two on oblique and one on odontoid views). The yield of the additional projections is one fracture per 9713 radiographic projections (90% confidence interval of one fracture per 1245-47,946 examinations). For two of the patients with fractures identified on the lateral projection, an additional fracture was seen when CT was then performed.


Performing additional radiographs of the cervical spine including AP, odontoid, and bilateral oblique projections in trauma patients with low pretest probability of fracture augments the diagnostic yield of lateral radiographs. Considering the potential for devastating neurological outcomes from missed cervical fractures, addition of AP, odontoid, and oblique projections continues to detect fractures at a low rate.


Cervical fracture; Cervical radiography; Cervical spine CT; Spine trauma

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center