Advanced Trauma Life Support (ATLS) 2025 – 400 Free Practice Questions to Pass the Exam

In cases of c-spine tenderness, especially in patients who are deemed unreliable—meaning they may not be able to provide a clear history or adequately cooperate during an examination—imaging studies are crucial for ruling out significant injuries. The persistence of c-spine tenderness warrants a careful approach to ensure that any potential spinal injury is appropriately assessed.

A CT scan is often utilized for its high sensitivity and specificity, especially in acute settings for detecting complex fractures and injuries. However, X-rays with flexion and extension provide critical information regarding the stability of the cervical spine. These studies help assess the range of motion of the spine and are particularly important in the setting of suspected ligamentous injury or instability.

Standard X-rays provide a general overview, but they may miss subtle fractures or indicate insufficient detail in assessing spinal stability. While ultrasound has a role in some assessments, it's not a conventional choice for evaluating c-spine injuries, particularly for fractures or subluxations.

Thus, utilizing X-rays with flexion and extension is a beneficial approach when persistent tenderness is present, and the patient’s reliability is in question. It allows for dynamic evaluation of the c-spine and can demonstrate instability that may not be visible on standard imaging.