Abstract
Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in “clearing”1 the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had “clay-shoveler” fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury.
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References
Borock E, Gabvain S, Jacobs L, et al. A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma 1991; 31: 1001–1005.
Norton W. Fractures and dislocations of the cervical spine. J Bone Joint Surg [Am] 1962; 44: 115–139.
Riggins RS, Kraus JF. The risk of neurologic damage with fractures of the vertebrae. J Trauma 1977; 17: 126–133.
Rogers WA. Fractures and dislocation of cervical spine: an end result study. J Bone Joint Surg [Am] 1957; 39: 341–376.
Mirvis S, Diaconis J, Chirico P et al. Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study. Radiology 1989; 170: 831–834.
Champion HR, et al. A revision of the trauma score. J Trauma 1989; 29: 623–629.
Gilpin DA, Nelson PG. A triage tool in the accident and emergency department. Br J Accident Surg 1991; 22: 35–37.
Acheson M, Livingston R, Richardson M, et al. High-resolution CT scanning in the evaluation of cervical spine fractures: comparison with plain film examinations. AJR 1987; 148: 1179–1185.
Brant-Zawadzki M, Miller EM, Federle MP. CT in the evaluation of spine trauma. AJR 1981; 136: 369–375.
Clark CR, Igram CM, El-Khoury GY, Ehara S. Radiographic evalulation of cervical injuries. Spine 1988; 13: 742–747.
Bachulis B, Long W, Hynes G, et al. Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg 1987; 153: 473–478.
Changaris D. Cervical spine films, cost and algorithms [editorial]. Am J Surg 1987; 153: 478.
Cadoux C, White J, Hedberg M, et al. High-yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med 1987; 16: 738–742.
Fischer R. Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 1984; 13: 905–907.
Hoffman JR, Schriger DL, Mower W, et al. Low-risk criteria for cervical spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992; 21: 1454–1460.
Kreipke DL, Gillespie KR, McCarthy MC, et al. Reliability of indications for cervical spine films in trauma patients. J Trauma 1989; 29: 1438–1439.
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Tehranzadeh, J., Bonk, R.T., Ansari, A. et al. Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma. Skeletal Radiol. 23, 349–352 (1994). https://doi.org/10.1007/BF02416991
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DOI: https://doi.org/10.1007/BF02416991