Would you get a CT (Computed Tomography) scan of the cervical spine for a throat injury?

CT Cervical Spine for Throat Injury

For a throat injury, CT of the cervical spine is recommended as the initial imaging modality due to its excellent ability to identify cervical spine fractures and potential vascular injuries that may accompany throat trauma. 1

Rationale for CT Cervical Spine in Throat Injury

CT is considered the gold standard for identification of cervical spine fractures and outperforms plain radiographs significantly. Key advantages include:

• Superior sensitivity for detecting cervical spine fractures compared to radiographs (which only identify about one-third of fractures visible on CT) 1
• Ability to evaluate both bony structures and some soft tissue injuries in a single examination
• Rapid acquisition time, which is crucial in trauma settings

Association Between Facial/Throat Trauma and Cervical Spine Injuries

There is a significant association between maxillofacial/throat injuries and cervical spine trauma:

• 7% of facial fracture patients have concomitant cervical spine injuries 1
• Higher incidence of cervical spine fractures (11.3% vs 7.8%) among patients with maxillofacial injuries compared to those without 1
• With increased severity of maxillofacial/throat injury, the likelihood of blunt cervical spine injury increases 1

Imaging Algorithm for Throat Injury

1. Initial Imaging: CT Cervical Spine

   • Provides excellent evaluation of bony structures
   • Can detect most clinically significant injuries
   • Should be performed without IV contrast initially 1

2. Additional Imaging Based on CT Findings and Clinical Presentation:

   • If neurological symptoms present: MRI cervical spine should follow CT to evaluate for soft tissue injuries including cord contusion, epidural hematoma, and nerve root avulsions 1
   • If vascular injury suspected: CTA (CT angiography) of the head and neck should be performed 1

When to Consider MRI After CT

MRI should be considered in the following scenarios:

• Neurological deficits present despite normal CT findings
• Suspected spinal cord or nerve root injury
• Inability to clinically clear the cervical spine (e.g., unconscious patient)
• Persistent neck pain despite normal CT findings

Recent studies have shown that MRI will identify soft-tissue injuries in 5% to 24% of blunt trauma patients with negative cervical spine CT 1. The Western Trauma Association Multi-Institutional trial reported that CT has a sensitivity of 98.5% for clinically significant injuries, but a small but significant incidence of missed injuries was noted 1.

Common Pitfalls to Avoid

1. Relying solely on plain radiographs: Radiographs miss approximately two-thirds of fractures visible on CT 1

2. Failing to obtain MRI when neurological symptoms are present: CT is significantly inferior to MRI in identifying soft-tissue pathologies such as spinal cord contusion, epidural hematoma, and nerve root avulsions 1

3. Missing vascular injuries: With throat trauma, there is risk of vascular injury that may require CTA evaluation 1

4. Inadequate evaluation of the cervicothoracic junction: Ensure complete visualization of the entire cervical spine including the C7-T1 junction 1

In summary, CT cervical spine is the appropriate initial imaging modality for throat injury, with MRI and/or CTA added based on clinical findings and initial CT results.