- Discussion:
- in the report by Davis, et al (2001), the authors evaluated the efficacy and safety of dynamic fluoroscopy flexion-extension examinations in identifying ligamentous cervical spine injury and clearing the cervical spine in patients with altered mental status after trauma;
- protocol required visualization of the entire cervical spine, through T1, through full extension and flexion under the direct supervision of a radiologist;
- oblique fluoroscopic views were obtained, as necessary, to visualize the cervicothoracic junction.
- fluoroscopic examinations were performed on 301 patients;
- there were 297 true-negative examinations, 2 true-positive examinations (stable injuries), 1 false-negative examination, and 1 false-positive examination;
- incidence of ligamentous injury identified by fluoroscopy in this study was 2 of 301 (0.7%);
- unstable cervical spine ligamentous injuries were identified in only 0.02% of all trauma patients;
- one patient developed quadriplegia when fluoroscopic evaluation was performed after two protocol violations;
- unstable cervical spine ligamentous injury without fracture is a rare occurrence;
- references:
- Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units--telephone survey of practice in south and west region.
- Routine Evaluation of the C Spine in Head-Injured Patients with Dynamic Fluoroscopy: a Reappraisal.
- Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy.
- Fluoroscopically Guided Passive Flexion-Extension Views of the Cervical Spine in the Obtunded Blunt Trauma Patient: a Commentary
- Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient.
- Cervical spine evaluation in obtunded or comatose pediatric trauma patients: A pilot study.
- in the report by Davis, et al (2001), the authors evaluated the efficacy and safety of dynamic fluoroscopy flexion-extension examinations in identifying ligamentous cervical spine injury and clearing the cervical spine in patients with altered mental status after trauma;
- protocol required visualization of the entire cervical spine, through T1, through full extension and flexion under the direct supervision of a radiologist;
- oblique fluoroscopic views were obtained, as necessary, to visualize the cervicothoracic junction.
- fluoroscopic examinations were performed on 301 patients;
- there were 297 true-negative examinations, 2 true-positive examinations (stable injuries), 1 false-negative examination, and 1 false-positive examination;
- incidence of ligamentous injury identified by fluoroscopy in this study was 2 of 301 (0.7%);
- unstable cervical spine ligamentous injuries were identified in only 0.02% of all trauma patients;
- one patient developed quadriplegia when fluoroscopic evaluation was performed after two protocol violations;
- unstable cervical spine ligamentous injury without fracture is a rare occurrence;
- references:
- Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units--telephone survey of practice in south and west region.
- Routine Evaluation of the C Spine in Head-Injured Patients with Dynamic Fluoroscopy: a Reappraisal.
- Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy.
- Fluoroscopically Guided Passive Flexion-Extension Views of the Cervical Spine in the Obtunded Blunt Trauma Patient: a Commentary
- Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient.
- Cervical spine evaluation in obtunded or comatose pediatric trauma patients: A pilot study.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Wednesday, January 9, 2013 12:24 pm