These patients would then undergo CT scanning. A recent study by Barba et al 13 found that initial CT scanning of the cervical spine increased the accuracy of detecting injuries from 54% to 100%.Īt our institution, it was also our experience that the initial 3-view radiographs of trauma victims were often inadequate in the evaluation of the cervical spine. 7 - 12 Because of these limitations, computed tomographic (CT) scanning has been used more frequently as an initial option for cervical spine clearance. However, plain radiographs and flexion-extension views frequently miss cervical spine and/or ligamentous injuries and have a sensitivity of only 85% to 90%. The traditional method of screening the cervical spine has been conventional radiographic series consisting of lateral, anteroposterior, and odontoid views. 4 - 6 In all other patients, radiographic clearance is required. This approach has been supported by several studies. Patients who are awake, alert, and lucid, have a normal neurologic examination result, and have no neck pain may be cleared clinically. 1 - 3 Rapid and accurate diagnosis and treatment of cervical spine injuries is, therefore, mandatory. Recent data have shown that cervical spine injury occurs in 2% to 6% of blunt trauma cases, and it is estimated that between 5% and 10% of these patients have worsening of their neurologic examination result due to errors in diagnosis or inadequate cervical spine protection. The neurologic consequences of a missed cervical spine injury may be devastating. No patient required operative management of spinal injury.Ĭonclusion Blunt trauma patients with normal motor examination results and normal CT results of the cervical spine do not require further radiologic examination before clearing the cervical spine.Īccurate identification and treatment of cervical spine injuries remains a challenge. None of the patients experienced neurologic deterioration. All of these MRI examination results were negative for injury. Twelve comatose patients (Glasgow Coma Scale score, <9), moving all 4 extremities on arrival, with normal CT results of the cervical spine, were examined with MRI. ![]() Seventeen patients had MRIs that showed degenerative disc disease, and 6 had spinal canal stenosis secondary to ossification. All MRI examination results were negative for clinically significant injury. Ninety-three patients had a normal admission motor examination result, a CT result negative for trauma, and persistent cervical spine pain, and were examined with MRI. Fifteen patients had admission neurologic deficits not seen on CT, and 7 of these patients had nonbony abnormalities on MRI. ![]() Eighty-five patients had a cervical spine injury diagnosed by CT. One hundred patients had cervical spine and/or spinal cord injuries. Of these patients, 56.2% had a closed head injury. Results During the study period, 2854 trauma patients were admitted, of whom 91.2% had blunt trauma. Neurologic examination and need for surgery were secondary outcomes. Main Outcome Measures Injury detected by CT and/or magnetic resonance imaging (MRI) of the cervical spine. Patients All patients admitted to the trauma service from January 1, 1999, to December 31, 2003. Setting Level II community-based trauma center. Hypothesis Trauma patients with normal motor examination results and normal cervical spine helical computed tomographic (CT) scans with sagittal reconstructions do not have significant cervical spine injury.ĭesign Prospectively collected registry data. Shared Decision Making and Communication. ![]() Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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