Cervical Spine Radiography and Trauma
When a patient goes to the emergency room after experiencing a blunt trauma, traditionally, practitioners use cervical spine radiography (CSR) to determine soft-tissue disorder or damage. The CSR is a static evaluation. The flexion-extension (FE)films, on the other hand, are also widely used since they, "are dynamic in that the technique places mechanical stress on the cervical spine via movement." FE consists of having the patient actively flex and extend the neck only to the point of pain. This study is a review article, that wanted to see how FE was being used in emergency departments, and, as a test, how it complimented the traditional CSR.
The tests were used in blunt trauma accident care: 334 motor vehicle accidents, 54 fall from height patients, 36 direct trauma to head-neck region subjects, and 27 others. 372 patients had normal static evaluations, and only 5 had abnormal dynamic CSR. The abnormalities included disruption of lines of cervical contour and posterior element abnormality. The authors write:
"All of the patients requiring invasive surgical stabilization had abnormalities on both static and dynamic CSR. This finding suggests that the most clinically significant and specific indication for the use of FE films may be abnormal static CSR."
So, the patient with abnormal static CSR was more likely to have an abnormal dynamic CSR. If a patient had a normal static CSR, but an abnormal dynamic CSR, they were treated non-invasively with a collar support. At the conclusion of the study, the authors support the use of CSR in an emergency care setting. They write, "All patients in the study underwent FE radiography without direct medical supervision and did not have complications, suggesting that the appropriate protocol executed by radiology technologists is both safe and adequate."
Brady WJ, Moghtader J, Cutcher D, et al. ED use of flexion-extension cervical spine radiography in the evaluation of blunt trauma. American Journal of Emergency Medicine 1999;17(6):504-508.
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