Suspected Spine Trauma

Question 1

Variant 1
Age greater than or equal to 16 years and less than 65 years. Suspected acute blunt cervical
spine trauma; imaging not indicated by NEXUS or CCR clinical criteria. Patient meets lowrisk criteria.
Initial imaging.

Answer 1

No imaging indicated

Question 2

Variant 2:
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Imaging
indicated by NEXUS or CCR clinical criteria.
Initial imaging.

Answer 2

1. CT without contrast (green)

2. radiographs (yellow)

Question 3

Variant 3
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma.
Confirmed or suspected cervical spinal cord or nerve root injury, with or without traumatic
injury identified on cervical CT.
Next imaging study.

Answer 3

1. MRI without contrast (green)

2. CT myelography (yellow)

Question 4

Variant 4
Age greater than or equal to 16 years. Acute cervical spine injury detected on radiographs.
Treatment planning for mechanically unstable spine.

Answer 4

1. CT without contrast (green)

2. MRI without contrast (green)

Question 5

Variant 5
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical
or imaging findings suggest arterial injury with or without positive cervical spine CT.
Next imaging study.

Answer 5

1. CTA head and neck with contrast (green)
2. MRA neck with and without contrast (green)
3. Arteriography cervicocerebral (yellow)
4. MRA without contrast (yellow)

Question 6

Variant 6
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma.
Obtunded patient with no traumatic injury identified on cervical spine CT.

Next imaging study after CT cervical spine without IV contrast.

Answer 6

MRI without contrast

Question 7

Variant 7
Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Clinical
or imaging findings suggest ligamentous injury.

Next imaging study after CT cervical spine
without IV contrast.

Answer 7

MRI without contrast