Assessing Cervical Spine Stability in Obtunded Blunt Trauma Patients: Review of Medical Literature

Radiology ◽  
2005 ◽  
Vol 234 (3) ◽  
pp. 733-739 ◽  
Author(s):  
Clint W. Sliker ◽  
Stuart E. Mirvis ◽  
Kathirkamanathan Shanmuganathan
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Medical Literature ◽  
Trauma Patients ◽  
Spine Stability

40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma?

2010 ◽  
Vol 76 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Jay Menaker ◽  
Deborah M. Stein ◽  
Allan S. Philp ◽  
Thomas M. Scalea
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Trauma Registry ◽  
Clinical Symptoms ◽  
Multidetector Ct ◽  
Trauma Patients ◽  
Mri Findings ◽  
Persistent Symptoms ◽  
Operative Repair ◽  
Ct Technology

We have recently demonstrated that 16-slice multidetector CT (MDCT) is insufficient for cervical spine (CS) clearance in patients with unreliable examinations after blunt trauma. The purpose of this study was to determine if a negative CS CT using 40-slice MDCT is sufficient for ruling out CS injury in unreliable blunt trauma patients or if MRI remains necessary for definitive clearance. In addition, we sought to elucidate the frequency by which MRI alters treatment in patients with a negative CS CT who have a reliable examination with persistent clinical symptoms. The trauma registry was used to identify all patients with blunt trauma who had a negative CS CT on admission using 40-slice MDCT and a subsequent CS MRI during their hospitalization from July 2006 to July 2007. Two hundred thirteen patients were identified. Overall, 24.4 per cent patients had abnormal MRIs. Fifteen required operative repair; 23 required extended cervical collar; and 14 had collars removed. A total of 8.3 per cent of patients with an unreliable examination and 25.6 per cent of reliable patients had management changed based on MRI findings. Overall, MRI changed clinical practice in 17.8 per cent of all patients. Despite newer 40-slice CT technology, MRI continues to be necessary for CS clearance in patients with unreliable examinations or persistent symptoms.

scholarly journals Impact of MRI on changing management of the cervical spine in blunt trauma patients with a ‘negative’ CT scan

2016 ◽  
Vol 1 (1) ◽  
pp. e000016 ◽  
Author(s):  
Mohamed A Mohamed ◽  
Karl D Majeske ◽  
Gul Sachwani-Daswani ◽  
Daniel Coffey ◽  
Karim M Elghawy ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Trauma Patients

scholarly journals Cervical spine fracture in geriatric blunt trauma: are the NEXUS criteria sensitive enough?

2019 ◽  
Vol 6 (9) ◽  
pp. 3038
Author(s):  
Katelyn A. Young ◽  
Christie L. Buonpane ◽  
Charles W. Walker ◽  
James T. Dove ◽  
Kenneth A. Widom ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Blunt Trauma ◽  
Geriatric Patients ◽  
Acute Injury ◽  
Cervical Spine Fracture ◽  
Trauma Patients ◽  
Cervical Fracture ◽  
Single Institution ◽  
Propensity Matching

Background: The NEXUS criteria lack an age consideration. This study characterizes NEXUS sensitivity for significant cervical fracture (CF) in non-geriatric (18-64 years) and geriatric (≥65 years) patients.Methods: This was a single-institution, retrospective review of blunt trauma patients (admitted between January 1, 2011 and December 31, 2016). Significant CF was an acute injury requiring surgery/orthosis. Propensity matching was used.Results: Overall, 353 patients had significant CF and notably 101 (28.6%) denied neck pain and tenderness at presentation. There were 162 geriatric patients with 17 patients who failed to meet any NEXUS criterion (sensitivity: 89.5%). The remaining 191 patients were non-geriatric, only six failed to meet any NEXUS criterion (sensitivity: 96.8%). NEXUS sensitivity was reduced among geriatric patients (89.5% vs. 96.8%, p=0.01), even after propensity matching (n=73/group; 86.3% vs. 97.3%, p=0.02).Conclusions: Alarmingly, 28.6% of patients with significant CF denied pain and tenderness. NEXUS demonstrated reduced sensitivity in the geriatric cohort, even after propensity matching. Liberal imaging is recommended for geriatric patients.

Cervical Spine Imaging in Blunt Trauma Patients

2016 ◽  
Author(s):  
Christoph I. Lee
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Trauma Patients ◽  
Clinical Context ◽  
Cervical Spine Injuries ◽  
Additional Information ◽  
Spine Imaging ◽  
Spine Injuries ◽  
Study Methodology ◽  
Spine Radiographs

This chapter, found in the back pain section of the book, provides a succinct synopsis of a key study examining the use of cervical spine imaging in blunt trauma patients. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study presents a set of five diagnostic criteria that approach 100% sensitivity for identifying clinically important cervical spine injuries and could eliminate one-eighth of all cervical spine radiographs ordered for these patients. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

Prehospital Factors Associated With Cervical Spine Injury in Pediatric Blunt Trauma Patients

2020 ◽  
Author(s):  
Lorin R. Browne ◽  
Fahd A. Ahmad ◽  
Hamilton Schwartz ◽  
Michael Wallendorf ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Trauma Patients ◽  
Factors Associated

The Current Role of Magnetic Resonance Imaging for Diagnosing Cervical Spine Injury in Blunt Trauma Patients with Negative Computed Tomography Scan

2012 ◽  
Vol 78 (10) ◽  
pp. 1156-1160 ◽  
Author(s):  
Meghann L. Kaiser ◽  
Matthew D. Whealon ◽  
Cristobal Barrios ◽  
Allen P. Kong ◽  
Michael E. Lekawa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Blunt Trauma ◽  
Multidetector Ct ◽  
Spine Injury ◽  
Trauma Patients ◽  
Resonance Imaging ◽  
Mri Findings

Clearance of cervical spine (CS) precautions in the neurologically altered blunt trauma patient can be difficult. Physical examination is not reliable, and although computed tomography (CT) may reveal no evidence of fracture, it is generally believed to be an inferior modality for assessing ligamentous and cord injuries. However, magnetic resonance imaging (MRI) is expensive and may be risky in critically ill patients. Conversely, prolonged rigid collar use is associated with pressure ulceration and other complications. Multidetector CT raises the possibility of clearing CS on the basis of CT alone. We performed a retrospective review at our Level I trauma center of all blunt trauma patients with Glasgow Coma Scale Score 14 or less who underwent both CT and MRI CS with negative CT. One hundred fourteen patients met inclusion criteria, of which 23 had MRI findings. Seven (6%) of these had neurologic deficits and/or a change in management on the basis of MRI findings. Although use of the single-slice scanner was significantly associated with MRI findings (odds ratio, 2.62; P = 0.023), no significant clinical risk factors were identified. Patients with MRI findings were heterogeneous in terms of age, mechanism, and Injury Severity Score. We conclude that CS MRI continues play a vital role in the workup of neurologically altered patients.

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