Flouroscopy in the Clearance of the Cervical Spine:

- 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, January 9, 2013 12:24 pm