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Abstract:

Whiplash lesions occur frequently after an acceleration-deceleration trauma, and patients often present at the emergency department with post trauma cervical complaints. Fearing to miss important cervical lesions, almost every patient presenting with trauma got imaging of the cervical spine in the past. Even today medical imaging procedures are overused after a whiplash trauma. Therefore inclusion criteria for imaging were introduced. The best known comprise the NEXUS and the Canadian C-spine rule criteria. Nationally the Riziv guidelines exist, which take into account the NEXUS criteria. Not only the indications for imaging are important, but also the number of views. In the acute phase at least 3 views are necessary: an antero-posterior, lateral and an open mouth odontoid view. In a later stage and to detect subtle instability and indirect signs of ligamentous tears, flexion and extension views must be performed. In the acute stage flexion/extension views are frequently false negative due to muscular spasm. CT is more sensitive for the detection of fractures and soft tissue lesions, such as a hematoma or a disk herniation. MR is even more sensitive for the detection of soft tissue lesions, such as ligamentous rupture or spinal cord contusions.