Technique and use of supine oblique views in acute cervical spine trauma

Turetsky, David B.; Vines, Frederick S.; Clayman, David A.; Northup, H M

doi:10.1016/s0196-0644(05)81848-7

Cited by 48 publications

(13 citation statements)

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“…Non-visualisation of the cervicothoracic junction on plain films may occur in up to 63% of cases [127,[132][133][134][135][136][137][138], typically requiring CT supplementation. Cervicothoracic injuries are characteristically more stable than upper cervical injuries but this cannot be assumed.…”

Section: Computerised Tomographymentioning

confidence: 99%

“…Some workers suggest an improved yield by routine use of oblique projections [131]. In one series, 6% of patients had injuries detected only on oblique views and a further 3.6% were difficult to see on traditional views [132]. While the swimmer's view (an oblique radiograph performed in the coronal plane with the arm closest to the X-ray beam elevated in a fashion reminiscent of the front crawl swimming stroke) and paired oblique views visualised the cervicothoracic junction in only 40% of cases, the latter allowed improved views of the posterior elements [133].…”

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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%

mentioning

confidence: 99%

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

Morris¹,

McCoy²

2004

Anaesthesia

106

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“…These views must adequately evaluate the levels of C1 to the C7 through T1 junction clearly. Some physicians are now recommending the trauma oblique view [35]. These are supine oblique views and they provide excellent visualization of the posterior elements, often down to thoracic level T2 through T3.…”

Section: Choice Of Studymentioning

confidence: 99%

Caring for the patients with cervical spine injuries: what have we learned?

Ghafoor

Martin

Gopalakrishnan

et al. 2005

Journal of Clinical Anesthesia

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“…3). In 1993, Turetsky et al [6] recommended the routine use of the five-view cervical spine series in the evaluation of all acute cervical spine trauma, citing the ability of five-view radiography to detect frac turns and ligamentous injury at and above the level ofthe cervicothoracicjunction (Fig. 4).…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of oblique radiography in the exclusion of C7-T1 injury in trauma patients.

Kaneriya

Schweitzer²,

Spettell³

et al. 1998

American Journal of Roentgenology

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OBJECTIVE. Thepurpose of ourstudywastocompare thecost-effectiveness of bilateral oblique radiography with that ofCT for excluding C7â€"Tl injury in trauma patients. MATERIALS AND METHODS. Usinga historical cohortmodel,we retrospectivelystudied two distinct groups of trauma patients. In the first group, which included 196 patients, CT was performed to show C7â€"Tlanatomy when this region was not adequately revealed on initial three-view cervical spine radiography. In the second group, which included 129 pa tients, routine three-view radiography was complemented by bilateral oblique views. If these five views failed to adequately reveal C7â€"Tlanatomy, CT was then performed to show the cervicothoracic junction. Using Medicare reimbursement data, we then compared the cost-ef fectiveness of CT with that of oblique radiography in terms of cost per cervical spine imaged completelyto the levelof C7â€"Tl. RESULTS. In thefirstgroup, 50 (26%)of 196patients underwent CT whenC7â€"Tl anatomy was not adequately revealed on routine three-view cervical spine radiography. In the sec ond group, only 17 ( I 3%) of the 129 patients required CT when five-view radiography failed to adequatelyrevealC7â€"Tl anatomy.This differencewas statisticallysignificant(p < .01). The cost per completely imaged cervical spine was $92.00 when bilateral oblique radiographs were routinely obtained, compared with $1 16.28 per completely imaged cervical spine when theseviews were not obtained. CONCLUSION. Because bilateral obliqueradiography appears to becost-effective forthe exclusion of cervical spine injuries, we suggest that it be performed routinely.

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Technique and use of supine oblique views in acute cervical spine trauma

Cited by 48 publications

References 10 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

Caring for the patients with cervical spine injuries: what have we learned?

The cost-effectiveness of oblique radiography in the exclusion of C7-T1 injury in trauma patients.

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