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Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients.
Eur Spine J. 2013 Jul; 22(7):1467-73.ES

Abstract

BACKGROUND

Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information.

METHODS

We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion-extension study for evaluation of potential cervical spine injury. All flexion-extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30° of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion-extension studies on clinical decision making was also reviewed.

RESULTS

One thousand patients met inclusion criteria for the study. Review of the flexion-extension radiographs revealed that 80% of the films either did not adequately demonstrate the C7/T1 junction or had less than 30° range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion-extension views had minimal effects on clinical decision making.

CONCLUSION

Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients.

Authors+Show Affiliations

Trauma and Emergency Surgery Program, University of California Davis Medical Center, 2315 Stockton Boulevard Ste 4212, Sacramento, CA 95817, USA. bonnie.mccracken@udmc.ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23404352

Citation

McCracken, Bonnie, et al. "Flexion and Extension Radiographic Evaluation for the Clearance of Potential Cervical Spine Injures in Trauma Patients." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 22, no. 7, 2013, pp. 1467-73.
McCracken B, Klineberg E, Pickard B, et al. Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients. Eur Spine J. 2013;22(7):1467-73.
McCracken, B., Klineberg, E., Pickard, B., & Wisner, D. H. (2013). Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 22(7), 1467-73. https://doi.org/10.1007/s00586-012-2598-z
McCracken B, et al. Flexion and Extension Radiographic Evaluation for the Clearance of Potential Cervical Spine Injures in Trauma Patients. Eur Spine J. 2013;22(7):1467-73. PubMed PMID: 23404352.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients. AU - McCracken,Bonnie, AU - Klineberg,Eric, AU - Pickard,Brian, AU - Wisner,David H, Y1 - 2013/02/13/ PY - 2012/05/08/received PY - 2012/11/15/accepted PY - 2012/10/31/revised PY - 2013/2/14/entrez PY - 2013/2/14/pubmed PY - 2014/3/4/medline SP - 1467 EP - 73 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 22 IS - 7 N2 - BACKGROUND: Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information. METHODS: We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion-extension study for evaluation of potential cervical spine injury. All flexion-extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30° of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion-extension studies on clinical decision making was also reviewed. RESULTS: One thousand patients met inclusion criteria for the study. Review of the flexion-extension radiographs revealed that 80% of the films either did not adequately demonstrate the C7/T1 junction or had less than 30° range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion-extension views had minimal effects on clinical decision making. CONCLUSION: Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients. SN - 1432-0932 UR - https://www.unboundmedicine.com/medline/citation/23404352/Flexion_and_extension_radiographic_evaluation_for_the_clearance_of_potential_cervical_spine_injures_in_trauma_patients_ L2 - https://doi.org/10.1007/s00586-012-2598-z DB - PRIME DP - Unbound Medicine ER -