For patients who require concomitant trauma surgery, lateral X-ray can be obtained after anesthesia and muscle relaxation prior to surgery to assess the stability of the cervical spine. Unlike in a standard lateral X-ray, lateral X-ray under axial traction provides the benefit of elongating the soft tissue of the neck, thus reducing muscle spasms that may obscure cervical spine instability on a standard lateral X-ray. Preoperative lateral X-ray under traction or after anesthesia and muscle relaxation should be used to evaluate occult instability of the cervical spine. Therefore, a more accurate and efficient protocol needs to be developed in order to prevent missed diagnoses of occult cervical spine instability. MRI provides detailed soft-tissue imaging but has a sensitivity of only 75% in detecting ligamentous injury. CT is the gold standard for detecting occult cervical spine fractures but is unable to detect instability in the cervical spine caused by injury to the intervertebral disc, ligament, or other soft tissue. For patients with cervical spine tenderness and/or neurological deficit, static lateral X-ray is the first-line imaging modality for assessing obvious fractures or dislocation of the cervical spine. ![]() Medical history, physical examination, and multiple radiological techniques are used to diagnose instability of the cervical spine after acute traumatic injury.
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