Obligatory medical device diagnostics.
- Radiographs of the cervical spine in two planes, additional oblique/target radiographs if necessaryIndications: following risk factors directly indicative of imaging: Age ≥ 65 years, dangerous mechanism of trauma, paresthesias (insensitivity) of the extremities; see also below under further indications: Exclusion of cervical spine injury clinically and without imaging.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and mandatory medical device diagnostics – for differential diagnostic clarification.
- Computed tomography of the skull (cranial CT, cranial CT or cCT) and cervical spine – in case of severe cervical spine acceleration trauma (cervical spine CT), neurological deficit, macroscopic soft tissue lesions or space-occupying lesions, abnormal conventional radiographic findings
- Magnetic resonance imaging (MRI) of the cervical spine – in case of suspected soft tissue damage (ligament injuries, hematoma (bruise), edema (water retention)), severe cervical spine acceleration trauma (cervical spine CT), neurological deficit, macroscopic soft tissue injury or space requirement.
- Doppler sonography (ultrasound examination that can dynamically visualize fluid flow (especially blood flow)) – if vascular injury is suspected.
- Diagnostics in cases of reasonable suspicion of injury to the nervous system or auditory or vestibular apparatus [S1 Guideline].
- Derivation of somatosensory evoked potentials (SEP; damage to the peripheral or central sensory system).
- Magnetically evoked motor potentials (MEP; damage to the peripheral or central motor system).
- Electromyogram (EMG, useful after 2-3 weeks; damage to the peripheral motor system).
- Nerve conduction velocimetry (NLG, F-wave; delineation of peripheral nonradicular nerve lesions).
- Sonography (ultrasound), excretory urogram, tonometry (bladder pressure measurement) in persistent micturition disorder (bladder emptying disorder) – to assess bladder function.
* S1 guideline
Further notes
- According to a meta-analysis, the benefit of additional MRI after blunt trauma to the spine is questionable: in 5,286 patients with blunt trauma to the cervical spine and negative CT findings, additional findings were found in 792 cases (= 15.0%); additional unstable injuries were found in only 16 cases not detected on CT (= 0.30%).
- Exclusion of cervical spine injury clinically and without imaging with sufficient certainty according to the Canadian C-Spine-rule study (sensitivity of 100%) according to the following criteria:
- <65 years
- No dangerous accident mechanism such as
- Fall from a height > 90 cm
- Axial force impact (e.g. diving accident)
- Accidents involving motorized recreational equipment, motorcycles or bicycles,
- High-speed accidents (> 100 km/h, with rollover, ejection).
- No paresthesias in the extremities.
- Sitting in the emergency room
- Ambulatory (at any time after injury)
- Examination: 45° neck rotation to the left and right possible.
