Utility of supine oblique radiographs in detecting cervical spine injury

A retrospective case-control study was performed to determine if the addition of supine oblique radiographs to the routine cervical spine series results in the detection of patients with cervical spine injuries not identified with standard views alone. The cervical spine radiographs of 82 patients with known cervical spine injuries and 180 hospitalized patients without cervical spine injuries were collected. Radiographs of the two patient groups were randomly combined to form the study sample. The radiographs were reviewed independently by a board-certified radiologist and a board-certified emergency physician. During the first phase, each reviewer was provided with standard views of the cervical spine (lateral, anterior-posterior, open-mouth odontoid, and submental views). During the second phase, each reviewer was provided with the standard views and supine obliques. The reviewers were masked to all clinical information and previous radiologic interpretations. The results showed that in the first phase (standard views only), the two physicians had a sensitivity of 81% (95% confidence interval [CI] 74-87%) and a specificity of 93% (95% CI 90-96%). In the second phase (obliques included), the two physicians had a sensitivity of 76% (95% CI 69-83) and specificity of 90% (95% CI 87-93%). In a subset analysis of patients with posterior element (lamina, facet, and pedicle) fractures, the two physicians had a sensitivity of 88% (95% CI 78-95%) with standard radiographs and 86% (95% CI 76-94%) with the addition of oblique radiographs. In conclusion the addition of supine oblique radiographs to the standard trauma cervical spine series did not increase the readers' sensitivity for detecting patients with cervical spine injuries. Routinely including oblique radiographs in patients undergoing radiographic screening of the cervical spine is not warranted.