CT Cervical Spine (Trauma)

Indications

• Blunt trauma per NEXUS / Canadian C-spine rule
• Evaluation of cervical fracture, dislocation, ligamentous injury surrogate
• Clearance of cervical spine in obtunded/intubated patients

Patient prep

• Maintain cervical collar/spinal precautions until cleared
• No contrast for routine trauma C-spine
• Remove necklaces; keep arms down to shoulders, avoid pulling on injured neck

Contrast

Technique

• Supine, neutral position with immobilization; do not reposition the neck
• Coverage from skull base (occiput) through T1-T2 to include cervicothoracic junction
• 120 kV with automated dose modulation; sub-mm collimation helical
• Recon: bone and soft tissue algorithms, 0.625-1 mm axial with 2-3 mm reformats
• Reconstruct sagittal and coronal in bone and soft tissue

Series / Sequences

Key points

• Must include occiput-C1 and C7-T1; missed CT junction is a common error
• Sagittal and coronal reformats essential for detecting subtle alignment/fracture
• If CTA neck indicated (e.g., facet fracture, transverse foramen involvement, severe mechanism), add per blunt cerebrovascular injury (BCVI) screening (Denver/modified criteria)
• Prevertebral soft tissue swelling is a clue to occult injury
• MRI complements CT for ligamentous/cord injury when neuro deficit or persistent concern

References