Trauma oblique x-rays and cervical spine injury

Report By: Dr AK Ghosh - ST1 Trauma & Orthopaedic Surgery.
Institution: Queens Hospital. London Deanery.
Date Submitted: 20th August 2008
Last Modified: 20th August 2008
Status: Blue (submitted but not checked)

Three Part Question

In [adult patients with trauma] do [trauma oblique x-rays] [increase the pickup rate of cervical spine injury]?

Clinical Scenario

A 35year old male attends A&E after significant trauma. He has pain on neck movement and is tender in the region of the cervical spine. Should trauma oblique x-rays be requested as routine? Should trauma oblique x-rays be requested if the AP/Lateral/peg (3 view) views show no injury?

Search Strategy

Medline 1966-07/08 using the OVID interface & ISI Web of Science via Web of Knowledge.
({[cervical] AND [spine]} AND {[oblique]})
The references and citations of all relevant papers were also reviewed.

Search Outcome

198 papers were found on Medline of which 3 were relevant.
98 papers were found on the Web of Science of which the same 3 papers were deemed relevant.
Reviewing references and citations of all relevant papers did not show any other relevant papers.

Comment(s)

Requesting oblique views has been advocated by authors for various reasons- as routine screening for cervical spine injury, as additional films when the 3view series is inconclusive and also to assess the posterior elements and the cervicothoracic junction (see BEST bet: Swimmers view or supine oblique views to visualise the cervicothoracic junction). However 2 of the 3 studies reviewed show no improvement in diagnostic sensitivity or specificity with these views. 1 study recommends inclusion of trauma oblique as standard, however this study’s deficiencies are listed in the table.

Clinical Bottom Line

In routine trauma, most studies show no improvement in detection of cervical spine injury with addition of trauma oblique x-rays to normal 3view x-rays.