Initiatives are under way in Canada and the United States to help identify the groups of patients with blunt trauma (whiplash associated disorders, WAD I and less commonly WAD II see the Table in the article 'Incidence of whiplash-associated disorder' for a definition) where the history and physical examination can clearly exclude significant pathology.ĭecision rules regarding the need for radiographs are being validated that will allow selective ordering of imaging studies. Simply stated, radiography is indicated if the possibility of a fracture exists. It is recognized that patients sustaining a cervical injury (whiplash) from a rear-end motor vehicle collision may be seen in a variety of settings including emergency departments, family doctors’ offices, and clinics. Some authorities still recommend the routine inclusion of plain film radiography for any case where trauma to the neck occurs and the clinical finding of midline posterior neck tenderness is present. Avoiding radiographs for those patients where the results are predicted to be normal translates to significant savings to our medical system and a reduction in the exposure of patients to ionizing radiation. An estimated 200 000 radiographs of the cervical spine are carried out annually in Canada on patients who have been injured through blunt or secondary trauma to the neck.

The indiscriminate use of radiographs has been primarily driven by the ever-present concern of cervical spine stability.

Cervical spine abnormal x ray