What is the role of imaging studies in the workup of C2 fractures?

Updated: Nov 21, 2018
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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The workup of suspected C2 fractures relies on imaging. Plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are all employed. [7, 8]  Plain film views should include anteroposterior (AP), lateral, and odontoid views. [9, 10]  Additionally, some authors recommend oblique views to better assess the posterior elements. (For specific radiographic findings, see Pathophysiology and Classification.)

Plain films tend to be better than CT for detecting subluxations and dislocations; CT usually is better for detecting most fractures and for characterizing the extent of the pathology. Most of the fractures missed on CT are those oriented in the axial plane or those involving the odontoid process. Plain radiography also is better for detecting vertebral body and spinous process fractures.

Plain films are used routinely as the study of first choice; if pathology is found, CT usually is performed next to help define the extent of the injury. If the plain film studies are not diagnostic and clinical suspicion remains high, then further evaluation using CT is mandatory.

Some clinicians advocate the use of three-dimensional (3D) CT reconstruction as both a diagnostic aid and a surgical template. However, its role has yet to be characterized fully. The role of MRI in spinal trauma is to aid in the characterization of soft-tissue injury, neural element injury, and disk injury. This is the study of choice for the evaluation of ligamentous and spinal cord injury, and is mandatory in any trauma patient with a neurologic deficit.

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