Abstract
Background
There are variations in cervical spine (CS) clearance protocols in neurologically
intact blunt trauma patients with negative radiological imaging but persistent neck
pain. Current guidelines from the current Eastern Association for the Surgery of Trauma
include options of maintaining the cervical collar or obtaining either magnetic resonance
imaging (MRI) or flexion-extension films (FEF). We evaluated the utility of FEF in
the current era of routine computerized tomography (CT) for imaging the CS in trauma.
Materials and methods
All neurologically intact, awake, nonintoxicated patients who underwent FEF for persistent
neck pain after negative CT scan of the CS at our level I trauma center over a 13-mo
period were identified. Their charts were reviewed and demographic data obtained.
Results
There were 354 patients (58.5% male) with negative cervical CS CT scans who had FEF
for residual neck pain. Incidental degenerative changes were seen in 37%—which did
not affect their acute management. FEF were positive for possible ligamentous injury
in 5 patients (1.4%). Two of these patients had negative magnetic resonance images
and the other three had collars removed within 3 wk as the findings were ultimately
determined to be degenerative.
Conclusions
In the current era, where cervical CT has universally supplanted initial plain films,
FEF appear to be of little value in the evaluation of persistent neck pain. Their
use should be excluded from cervical spine clearance protocols in neurologically intact,
awake patients.
Keywords
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Article info
Publication history
Published online: June 24, 2013
Accepted:
May 30,
2013
Received in revised form:
April 29,
2013
Received:
January 7,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
