D - DIAGNOSTIC IMAGING
In the awake, symptomatic patient, high-quality computed tomography (CT) imaging of the cervical spine is recommended. (Adapted from CNS-RADIO 2013, p.54; Level A)
If high-quality CT imaging is available, routine 3-view cervical spine radiographs are not recommended. (CNS-RADIO 2013, p.54; Level A)
If high-quality CT imaging is not available, a 3-view cervical spine series (anteroposterior, lateral, and odontoid views) is recommended. This should be supplemented with CT (when it becomes available), if necessary, to further define areas that are suspicious or not well visualized on the plain cervical x-rays. (CNS-RADIO 2013, p.54; Level A)
In the awake patient with neck pain or tenderness and normal high-quality CT imaging or normal 3-view cervical spine series (with supplemental CT if indicated), the following recommendations should be considered:
- continue cervical immobilization until asymptomatic
- discontinue cervical immobilization following normal and adequate dynamic flexion/extension radiographs
- discontinue cervical immobilization following a normal magnetic resonance imaging (MRI) obtained within 48 hours of injury (limited and conflicting Class II and Class III medical evidence), or
- discontinue cervical immobilization at the discretion of the treating physician.