Economic Evaluation and Health Care Cost-utility analysis

The emergency clinician must be aware-that the absence of radiological abnormality reduces the chances of spinal injury but does not exclude it. About 8% of patients have injuries to the cervical spine in more than one place and 15% of patients with cervical injury also have a thoracolumbar injury Make sure all seven cervical vertebrae and the C7/T1 junction are visible. The spinous processes may not be clear. Ifyou suspect an injury obtain a further view. Physiological subluxation of the bodies ofC2 on C3 (seen in a quarter of cases) and C3 on C4 (seen in 15% of cases) occurs up to 8 years of age. However, the posterior spinal line is maintained. Artefactual shadows can sometimes cause confusion. In the open mouth view the vertical cleft between the upper two incisor teeth may be mistaken for a vertical fracture ofthe peg. Do not forget to examine the soft tissue shadows; these may be the only clues to an underlying fracture.