Delayed Diagnosis of Cervical Spine Injuries

Gerrelts, Brian D.; Petersen, Elizabeth U.; Mabry, John W.; Petersen, Scott R.

doi:10.1097/00005373-199112000-00010

Cited by 180 publications

(77 citation statements)

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“…In one series, plain films detected 58% of fractures and 93% of subluxations or dislocations (94% of all abnormalities), while CT detected 90% of fractures and 54% of subluxations or dislocations (92% of all abnormalities) [136]. Therefore, CT may miss more ligamentous injuries and malalignments, and plain films more fractures [125,127,138], but the combination is especially powerful, consistently achieving 100% sensitivity in a number of studies [33,125,[127][128][129][136][137][138]. Furthermore, in addition to excellent sensitivity, the use of combined plain films and CT in 879 patients allowed 'major' (associated mechanical instability or neurological findings) and 'minor' injuries to be reliably and functionally distinguished [145].…”

Section: Computerised Tomographymentioning

confidence: 99%

“…While craniocervical and cervicothoracic spinal injuries are the most common, isolated mid-cervical injuries are well recognised. In one series, had entire cervical spine CT been omitted while patients were unconscious, three cervical injuries at C2, C5 and C6 ⁄ C7 would have been missed [125]. No cervical spine injuries were missed following 158 entire CT scans in combination with plain films [147].…”

Section: Computerised Tomographymentioning

confidence: 99%

“…The sensitivity of an adequate cervical series ranges from 72% to > 99% [7,8,34,100,[123][124][125], but many studies evaluating the cervical series have either been small or retrospective. The NEXUS (National Emergency X-Radiography Utilisation Study) group conducted the largest prospective evaluation of trauma radiographs to date [32].…”

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confidence: 99%

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Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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Section: Computerised Tomographymentioning

confidence: 99%

Section: Computerised Tomographymentioning

confidence: 99%

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Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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“…6,8,9,13,14,[21][22][23]29 Furthermore, present measurement techniques are based on bony landmarks, which may be better visualized on CT scans over plain radiographs and MR images.…”

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confidence: 99%

Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group

Vachhrajani

Sen

Satyan

et al. 2014

PED

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Object Upper cervical spine injuries in the pediatric age group have been recognized as extremely unstable from ligamentous disruption and as potentially lethal. Few measurement norms have been published for the pediatric upper cervical spine to help diagnose this pathological state. Instead, adult measurement techniques and results are usually applied inappropriately to children. The authors propose using high-resolution reconstructed CT scans to define a range of normal for a collection of selected upper cervical spine measurements in the pediatric age group. Methods Sagittal and coronal reformatted images were obtained from thin axial CT scans obtained in 42 children (< 18 years) in a 2-month period. There were 25 boys and 17 girls. The mean age was 100.9 months (range 1–214 months). Six CT scans were obtained for nontrauma indications, and 36 were obtained as part of a trauma protocol and later cleared for cervical spine injury. Six straightforward and direct linear distances—basion-dental interval (BDI); atlantodental interval (ADI); posterior atlantodental interval (PADI); right and left lateral mass interval (LMI); right and left craniocervical interval (CCI); and prevertebral soft-tissue thickness at C-2—that minimized logistical and technical distortions were measured and recorded. Statistical analysis including interobserver agreement, age stratification, and sex differences was performed for each of the 6 measurements. Results The mean ADI was 2.25 ± 0.24 mm (± SD), the mean PADI was 18.3 ± 0.07 mm, the mean BDI was 7.28 ± 0.10 mm, and the mean prevertebral soft tissue width at C-2 was 4.45 ± 0.43 mm. The overall mean CCI was 2.38 ± 0.44 mm, and the overall mean LMI was 2.91 ± 0.49 mm. Linear regression analysis demonstrated statistically significant age effects for PADI (increased 0.02 mm/month), BDI (decreased 0.02 mm/month), and CCI (decreased 0.01 mm/month). Similarly significant effects were found for sex; females demonstrated on average a smaller CCI by 0.26 mm and a smaller PADI by 2.12 mm. Moderate to high interrater reliability was demonstrated across all parameters. Conclusions Age-dependent and age-independent normal CT measurements of the upper cervical spine will help to differentiate physiological and pathological states in children. The BDI appears to change significantly with age but not sex; on the other hand, the LMI and ADI appear to be age-independent measures. This preliminary study suggests acceptable levels of interrater reliability, and further expanded study will aim to validate these measurements to produce a profile of normal upper cervical spine measurements in children.

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“…[19] Gerrelts et al found that patients with a delayed diagnosis of cervical spine fracture did not develop permanent neurological deficits. [27] There were no case-control studies that directly compared the outcomes of patients who were immobilised against those that were not. This was possibly due to the ethical and litigious difficulties in creating such a study Four systematic reviews have also concluded that there is insufficient evidence to validate the potential benefits of phSI.…”

Section: Benefitsmentioning

confidence: 99%

The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

Purvis

Carlin

Driscoll

2017

The American Journal of Emergency Medicine

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Intro:The routine practice of pre-hospital spinal immobilisation (phSI) for patients with suspected spinal injury has existed for decades. However, the controversy surrounding it resulted in the 2013 publication of a Consensus document by the Faculty of Pre-Hospital Care. The question remains as to whether the quality of evidence in the literature is sufficient to support the Consensus guidelines. This critical review aims to determine the validity of current recommendations by balancing the potential benefits and side effects of phSI. Method.A review of the literature was carried out by two independent assessors using Medline, PubMed, EMBASE and the Cochrane Library databases. Manual searches of related journals and reference lists were also completed. The selected body of evidence was subsequently appraised using a checklist derived from SIGN and CASP guidelines, as well as Crombie's guide to critical appraisal.

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Delayed Diagnosis of Cervical Spine Injuries

Cited by 180 publications

References 0 publications

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group

The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation

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