Routine Evaluation of the Cervical Spine in Head-Injured Patients with Dynamic Fluoroscopy: A Reappraisal

Davis, James W.; Kaups, Krista L.; Cunningham, Mark A.; Parks, Steven N.; Nowak, Thomas; Bilello, John F.; Williams, Justin

doi:10.1097/00005373-200106000-00011

Cited by 107 publications

(59 citation statements)

References 14 publications

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“…'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 to the individual and society are common and severe.…”

Section: Discussionmentioning

confidence: 99%

“…The worldwide literature reports 887 patients undergoing dynamic fluoroscopy in 10 separate studies [22,24,36,37,116,[187][188][189][190][191] (Table 1).…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

“…A total of 15 (1.7%) cervical injuries were detected following normal baseline imaging, typically plain films and directed CT. Of these 15 patients, one was detected with plain films [189], four with CT [22,24,36] and two were missed. Among the remaining eight, high resolution CT was never performed at the injured level, so combined plain films and CT detected 5 ⁄ 7 (71.4%) unstable injuries.…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

“…Evaluation using mechanism of injury may be misleading. Patton et al [97] have stated that blunt assault victims do not suffer isolated ligament injuries and their cervical spine may be cleared with plain radiographs alone, yet Davis et al [22] reported this injury in a blunt assault victim. Multivariate analysis of risk factors for cervical injury has consistently identified head injury or high energy mechanism, but the 95% confidence intervals are wide (relative risks: 4.0-17.0 and 5.4-25.0, respectively), limiting exclusion of injury in the individual patient [14].…”

mentioning

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: Discussionmentioning

confidence: 99%

“…The worldwide literature reports 887 patients undergoing dynamic fluoroscopy in 10 separate studies [22,24,36,37,116,[187][188][189][190][191] (Table 1).…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

Section: Dynamic Fluoroscopymentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Morris¹,

McCoy²

2004

Anaesthesia

106

View full text Add to dashboard Cite

show abstract

“…35 Most studies do not report adverse effects of the examination itself, if performed by protocol, but this technique did miss some relevant unstable injuries with potential large adverse effects, respectively a dens fracture, one C6-C7 and one C7-Th1 subluxation. 57,58,61 …”

mentioning

confidence: 99%