Cervical trauma imaging reinvented: the expanding role of ultrasound

Cervical spine trauma represents a critical emergency requiring prompt and accurate imaging to guide management and prevent irreversible neurological damage. While computed tomography (CT) is considered the diagnostic gold standard, ultrasonography (US) has emerged as a viable alternative or adjunct, particularly in environments where CT is unavailable or in populations vulnerable to ionizing radiation, such as children. This systematic review aimed to evaluate the diagnostic accuracy, clinical utility, and limitations of ultrasound in the acute assessment of cervical spine injuries. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science through July 2025. Studies were selected based on pre-defined inclusion criteria, focusing on original clinical investigations reporting the use of ultrasound in acute cervical trauma. Data were extracted regarding sample size, US modality, diagnostic metrics (sensitivity, specificity, predictive values), and clinical outcomes. Quality assessment was conducted using the QUADAS-2 tool. A total of 30 studies were included. Results demonstrated that point-of-care ultrasound (POCUS) offers high specificity (up to 98%) and moderate sensitivity in identifying cervical fractures and spinal misalignment. Color Doppler imaging proved effective in detecting vascular injuries such as vertebral artery dissection or thrombosis. Intraoperative ultrasound enhanced surgical precision, and pediatric applications showed promise for minimizing radiation exposure. However, limitations included operator dependence, reduced visualization of deep or posterior structures, and variability in training protocols. In conclusion, ultrasound is a promising, rapid, and radiation-free modality for selected cases of cervical spine trauma, particularly in pediatric or resource-limited settings, though it should complement rather than replace advanced imaging.