#Normal lateral cervical spine x ray skin

Patients with a diagnosis of penetrating trauma were excluded, as were patients under the age of 18. These criteria were selected so as to find the highest yield of patients having undergone ULCR as part of their workup to identify cervical instability. The Trauma Registry at Denver Health Medical Center, an academic regional Level I Trauma Center, was queried to identify all those patients who presented to our institution between Apthru Mawith a history trauma, who had a Glasgow Coma Score of 12 or less, or who were intubated prior to or shortly after arrival to DHMC. We sought to review this experience to determine whether this exam provided a reliable basis for determining the safety of removing cervical immobilization.Īpproval from the Colorado Multiple Institutional Review Board was obtained prior to initiation of this study (COMIRB #04-1118). Griffen has speculated that, as patients are moved by the nursing staff for routine nursing care, unstable injuries may be revealed when the upright film is performed. Specifically, the theory that elevating the patient to 90°, while still in the collar for the exam, will provide a 'stressed' exam which may uncover an unstable injury. The rationale for the use of the ULCR was similar to the protocol later described by Griffen and co-workers. These shortcomings have led to the search for other studies that might identify patients with instability, when plain radiographs and CT scans are normal.Īt this institution, between 20, a protocol was established for the evaluation of the cervical spine in the trauma patient that included an upright lateral cervical radiograph (ULCR) in patients who remained unable to reliably answer questions about neck pain, had no apparent neurologic deficits, and normal plain cervical radiographs.

#Normal lateral cervical spine x ray skin

The need to rapidly remove immobilization devices is additionally vital to reduce the risk of pressure-related skin breakdown. Conversely, some have argued that MRI must be performed within 48 hours to be useful, while others have challenged its specificity. There has been concern about the potential of the former to cause neurologic injury. Most of the attention in the literature has focused on the use of either flexion-extension radiographs or MRI for this purpose. In particular, detection of instability in the absence of bony fractures is of concern to all who treat the trauma patient. Much of the debate centers around what is the minimum radiographic workup necessary prior to removing cervical immobilization devices. There is considerable debate regarding 'clearance of the cervical spine' in trauma patients who are uncooperative or unable to give a reliable history. We therefore cannot recommend the use of ULCR in the obtunded trauma patient. ULCR are inferior to both CT and MRI in the detection of cervical injury in patients with normal plain radiographs. ULCR had an apparent sensitivity of 45.5% and specificity of 71.4%. None of the missed injuries required surgical stabilization, although one had a vertebral artery injury demonstrated on subsequent angiography. Six patients had ULCR interpreted as normal, but had abnormalities on either CT or MRI.

The seventh patient's only abnormality was soft tissue swelling MRI was otherwise normal.

Seven patients had studies interpreted to be abnormal, of which six were also abnormal, by either CT or MRI.

We retrospectively reviewed our experience with ULCR in 683 blunt trauma victims who presented over a 3-year period, with either a Glasgow Coma Score <13 or who were intubated at the time of presentation. An upright lateral cervical radiograph (ULCR) was performed in selected patients to investigate whether this study could provide this same information, to enable removal of cervical immobilization devices in the multiple trauma patient. Dynamic radiographs or MRI are thought to demonstrate unstable injuries, but can be expensive and cumbersome to obtain. The best method for radiographic 'clearance' of the cervical spine in obtunded patients prior to removal of cervical immobilization devices remains debated.