RADIOGRAPHIC ASSESSMENT OF THE CERVICAL SPINE IN SYMPTOMATIC TRAUMA PATIENTS RECOMMENDATIONS Standards: A three view cervical spine series (AP, lateral, and odontoid views) is recommended for radiographic evaluation of the cervical spine in patients

RECOMMENDATIONS Standards: A three view cervical spine series (AP, lateral, and odontoid views) is recommended for radiographic evaluation of the cervical spine in patients who are symptomatic following traumatic injury. This should be supplemented with computed tomography to further define areas that are suspicious or not well visualized on the plain cervical x-rays. Guidelines: There is insufficient evidence to support treatment guidelines. Options: • It is recommended that cervical spine immobilization in awake patients with neck pain or tenderness and normal cervical spine x-rays (including supplemental CT as necessary) be discontinued following either: a) Normal and adequate dynamic flexion/extension radiographs; or b) Normal MRI study obtained within 48 hours of injury. • Cervical spine immobilization of obtunded patients with normal cervical spine x-rays (including supplemental CT as necessary) may be discontinued: a) Following dynamic flexion/extension studies performed under fluoroscopic guidance; or b) Following a normal MRI study obtained within 48 hours of injury; or c) At the discretion of the treating physician. RATIONALE Trauma patients who are symptomatic, that is, complain of neck pain, have cervical spine tenderness, or have symptoms or signs of a neurological deficit associated with the cervical spine,