Emergency Radiology

, Volume 26, Issue 2, pp 133–138 | Cite as

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

  • Brian M. HaasEmail author
  • Lewis D. Hahn
  • Isabel Oliva
Original Article



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 radiography Spine trauma Cervical fracture Cervical spine CT 



The Yale University institutional review board approved this HIPAA compliant study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© American Society of Emergency Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of RadiologyStanford UniversityStanfordUSA
  3. 3.Department of Radiology and Biomedical Imaging, Yale School of MedicineYale UniversityNew HavenUSA

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