The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques. It is important that cases are handled by a suitably skilled multidisciplinary team, and avoid repeat imaging due to technical inadequacies. Any areas of oedema or collapse then require detailed CT evaluation. If the patient is to have an MRI scan, the MR unit must be able to at least do a sagittal STIR sequence of the entire vertebral column to exclude non-contiguous injuries, which, since the advent of MRI, are now known to be relatively common. It is also the investigation of choice for evaluating the complications and late sequela of trauma. Patients with focal neurological signs, evidence of cord or disc injury, and patients whose surgery require pre-operative cord assessment should be imaged by MRI. If the lateral cervical radiograph and the CT scan are negative, then MRI is the investigation of choice to exclude instability. The cranio-cervical scans should be a maximum of 2 mm thickness, and probably less, as undisplaced type II peg fractures, can be invisible even on 1 mm slices with reconstructions. If a patient is unconscious then CT of the brain and at least down to C3 (and in the USA down to D1) has now become routine. The rapid primary clinical survey should be followed by lateral cervical spine, chest and pelvic radiographs. Never the less there appears to be an emerging consensus for the multiply injured patient. This test is prescribed to find the cause of neck pain, look for injury of the spinal bones. Dense structures such as the bones appear white, while softer tissues such as the skin and muscles appear darker. MRI and multislice CT technology have made rapid advances, but the literature is slower to catch up. This test helps visualize intervertebral discs and the surrounding soft tissues like skin and muscles. The issue has been contentious for many years and has resulted in burgeoning but inconclusive guidance. Ethical concerns have hindered any randomised control blinded studies on the imaging required to assess the cervical spine in an unconscious trauma patient.
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