Posted as supplied by authors.

Table A: General Principles of combined plain radiography and CT screening for CSI[31]

Suboptimal and anatomically incomplete imaging, combined with misinterpretation account for the largest number of missed injuries

The craniocervical and cervicothoracic junctions frequently "conceal" injuries and 25% of plain films are technically inadequate. CT allows evaluation of these sites, especially among intubated patients

CT typically detects more fractures, plain films detect more malalignments; the two modalities performing in a complimentary fashion

The three view cervical plain radiography series and directed CT consistently detect >99% of CSI

Entire cervical spine CT may detect injuries in a further 8-14% of patients

CT scanning does not add excessive time to trauma evaluations and is time and cost-effective

High resolution CT at 1.5-2mm collimation and pitch may be the best compromise between sensitivity, scan-time and radiation dose

Posted as supplied by author.

Table B: Summary of studies of dynamic fluoroscopy

Author And Study	Number Of Evaluations (n)	Results	NOTES:
Davis et al^w7	301	2 "relatively" stable injuries	1 false negative:paparesis
Marciano et al^w8	194	0 unstable injury
Harris et al^w9	149	3 unstable injury	8 studies inadequate
Cox et al^w10	91	4 unstable injuries	1 required surgery
Brooks et al^w11	73	1 unstable injury	Suggested on plain films
Ajani et al²¹	48	1 unstable injury	Seen on CT and MRI
Sees et al^w12	20	1 unstable injury	Seen on CT
Chendrasekhar et al^w13	8	0 unstable injuries
Beirne et al^w14	2	2 unstable injuries	Seen at CT
Robert et al^w15	1	1 unstable injury
TOTAL:	887 evaluations	15 cervical spine injuries (1.7%), 10 with dynamic testing (0.9%)	5 seen otherwise, 8 lesions not CT scanned

Posted as supplied by authors.

Web extra references

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w3 PA Farling. Anaesthesia in the magnetic resonance unit: a hazardous environment. Anaesthesia 2002;57:421-3.

w4 Mirvis SE. Fluoroscopically guided passive F/E views of the cervical spine in the obtunded blunt trauma patient: a commentary. Emerg Radiol 2001;8:3-5.

w5 Bolinger B, Shartz M, Marion D. Bedside fluoroscopic flexion and extension cervical spine radiographs for clearance of the cervical spine in comatose trauma patients. J Trauma 2004;56:132-6.

w6 Blahd WH, Iserson KV, Bjelland JC. Efficacy of the posttraumatic cross table lateral view of the cervical spine. J Emerg Med 1984;2:243-9.

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w8 Marciano FF, Apostolides PJ, Vishteh AG, Baskin JJ, Sonntag VKH. Cervical spine management in severe nonpenetrating closed head injury: a prospective study. Neurosurg 1997;41:740-1.

w9 Harris MB, Kronlage SC, Carboni PA, Robert KQ, Menmuir B, Ricciardi JE, et al. Evaluation of the cervical spine in the polytrauma patient. Spine 2000;25:2884-91.

w10 Cox MW, McCarthy M, Lemmon G, Wenker J. Cervical spine instability: clearance using dynamic fluoroscopy. Curr Surg 2001;58:96-100.

w11 Brooks RA, Willett KM. Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient. J Trauma 2001;50:862-7.

w12 Sees DW, Rodriguez Cruz LR, Flaherty SF, Ciceri DP. The use of bedside fluoroscopy to evaluate the cervical spine in obtunded patients. J Trauma 1998;45:768-71.

w13 Chendrasekhar A, Moorman D, Timberlake GA. An evaluation of the effects of semirigid collars in patients with severe closed head injury. Am Surg 1998;64:604-6.

w14 Beirne JC, Butler PE, Brady FA. Cervical spine injuries in patients with facial fractures: a 1 year prospective study. Int J Oral Maxillofac Surg 1995;24:26-9.

w15 Robert KQ, Ricciardi JE, Harris MD. Occult ligamentous injury of the cervical spine. South Med J 2000;93:974-6.