Significant new observations on cervical spine trauma.

The results of a computer analysis of 399 patients with documented fractures and/or dislocations of the cervical spine are summarized. Vertebral arch fractures were present in half of all patients with radiographic evidence of cervical spine trauma. Two-thirds of the patients had two or more injuries. Isolated disk injuries were rare and, when present, were characterized by a vacuum sign. The dens fracture, with or without atlantoaxial dislocation, was rarely associated with injury elsewhere in the cervical spine. The study suggests that the routine five-film cervical spine examination is inadequate to detect the most common traumatic lesions. Thus vertebral arch views (pillar views) should be obtained if there is evidence to suggest hyperextension as the mechanism of injury. In addition, the study underscores the importance of aggressively searching for multiple abnormalities.