Accuracy of standard radiographic views in detecting cervical spine fractures

David R. Streitwieser, Robert Knopp, Lee R. Wales, Justin L. Williams, Kent Tonnemacher

Research output: Contribution to journalArticlepeer-review

129 Scopus citations


Recent studies have challenged the accuracy of standard radiographs for detecting cervical spine injuries. We used thin-section tomography to determine the accuracy of the cross-table lateral view (CTLV) alone, and the three standard emergency department views (CTLV, anteroposterior, and open-mouth) together, for detecting acute cervical spine fractures. Seventy-one patients with blunt cervical spine injuries had thin-section tomography performed for the following indications: fracture, dislocation, or suspicious findings on standard radiographs; or persistent severe pain or neurologic deficit. Tomography detected acute fractures in 44 of the 71 patients. The CTLV had a sensitivity of 82%, specificity of 70%, and accuracy of 77% for detecting patients with fractures. The three standard views had a corresponding sensitivity, specificity, and accuracy of 93%, 71%, and 84%, respectively. Eight patients with fractures had the CTLV interpreted as normal, and three patients with fractures had all three standard views interpreted as normal. The use of thin-section tomography is recommended when there are suspicious radiographic or clinical findings suggesting a severe cervical spine injury.

Original languageEnglish (US)
Pages (from-to)538-542
Number of pages5
JournalAnnals of Emergency Medicine
Issue number9
StatePublished - Sep 1983


  • cervical spine, fracture, radiography
  • radiography, cervical spine
  • spine, fracture, radiography


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