Systematic Interpretation of the Spinal Radiograph Case 1

1. Question

It is 10:00 am on a Monday morning. You are asked to assess a 48-year-old male who has been brought into the emergency department following a road traffic collision. The patient states that he was stationary at the traffic lights, when he was hit from behind at about 20 mph. When the patient walked over to the other car to exchange insurance details, the driver sped off. To make matters worse, the paramedics insisted on strapping him to a board when they arrived.

The patient is complaining of severe neck pain but denies other injuries or significant past history. He is demanding that you ‘sort him out’ as quickly as possible so that he can speak to the police.

On examination he is lying on a long board with his head and neck immobilised in collar, blocks and tape. His vital signs are:

HR 78
BP 114/76
RR 15
SpO₂96% in air
GCS 15

He has no focal neurological deficit. No other injuries are found.

Midline tenderness on examination would mandate an x-ray of his cervical spine
X-rays are required due to the pre-hospital immobilisation
He should be taken off the board at the earliest opportunity
He has no low-risk features
His neck movements may be assessed before x-ray

2. Question

He has had a low-risk mechanism of injury. You elect to take him off the board and assess his neck movements. These are greatly reduced. He can only rotate his neck to 25° bilaterally.

Which one of the following options is the first line in imaging for this patient?

Lateral cervical spine x-ray
AP, peg and lateral cervical spine x-rays
AP, peg, lateral and supine oblique cervical spine x-rays
CT cervical spine

3. Question

The patient’s x-rays are shown below (Figs 1-3).

Click on the x-rays to enlarge.

Report your findings below.


Fig 1: Lateral view	Fig 2: Peg view	Fig 3: AP view