Cervical spine clearance in unconscious traumatic brain injury patients: dynamic flexion-extension fluoroscopy versus computed tomography with three-dimensional reconstruction

The Journal of Trauma
Laven PadayacheeThomas Kossmann

Abstract

An optimal protocol for clearing the cervical spine in unconscious patients with traumatic brain injury remains controversial. Protocols include plain radiographs and computed tomography (CT), and ligamentous injury may be identified with flexion-extension radiographs. We questioned whether cervical CT with three-dimensional (3D) reconstructions may obviate the need for flexion-extension radiology in the detection of occult ligamentous injury. Between July 1999 and November 2001, 276 unconscious traumatic brain injured patients admitted to The Alfred Hospital received cervical spine plain radiographs, CT with 3D reconstructions, and dynamic flexion-extension X-ray studies with fluoroscopy as part of a routine protocol. These patients were identified from a prospective intensive care unit database and all radiology reports were reviewed. Dynamic flexion-extension X-ray studies with fluoroscopy identified no new fractures or instability; there were no instances of true-positive results. Dynamic flexion-extension was true-negative in 260 of 276 (94%) patients, falsely positive in six patients (2.2%) and falsely negative in one (0.4%) patient. In nine patients, dynamic flexion-extension was inadequate. Dynamic flexion-extension X-r...Continue Reading

References

Sep 1, 1995·The Journal of Trauma·J W DavisR W Smith
Sep 2, 1995·BMJ : British Medical Journal·E EypaschH Troidl
Nov 10, 1998·Anaesthesia and Intensive Care·A E AjaniD V Tuxen
Apr 8, 1999·Anaesthesia·J Nicholl, S Willatts
Sep 27, 2002·Skeletal Radiology·Harry J GriffithsMichael Metzler

❮ Previous
Next ❯

Citations

Mar 13, 2012·Intensive Care Medicine·James O M Plumb, C G Morris
Mar 16, 2013·European Journal of Radiology·J C SierinkJ C Goslings
Jul 14, 2009·Southern Medical Journal·Daniel M Sciubba, Rory J Petteys
Mar 12, 2010·The Journal of Trauma·Deirdre HennessyJohn B Kortbeek
May 31, 2011·Journal of Neurosurgery·Vincent C Traynelis, Manish K Kasliwal
Nov 5, 2008·Neurosurgical Focus·Andrew H MilbySherman C Stein
Jan 1, 2011·SAS Journal·William R S HudsonAntonio E Castellvi
Mar 13, 2014·Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses·Jackie S Smith
Jul 31, 2008·Emergency Radiology·Mark SchoenwaelderDinesh Varma
Apr 28, 2009·Emergency Radiology·Joseph J JunewickJeffrey M Hinman
Oct 31, 2009·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·J R DusseldorpR J Mobbs
Oct 30, 2007·Journal of the American College of Radiology : JACR·Richard H Daffner, David B Hackney
Sep 11, 2007·Emergency Medicine Clinics of North America·Amy Kaji, Robert Hockberger
Dec 30, 2014·The Spine Journal : Official Journal of the North American Spine Society·Murat PekmezciR Trigg McClellan
Jun 11, 2019·British Journal of Hospital Medicine·Christopher DeaconBenjamin J Ollivere
Aug 24, 2019·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·P K Karthik YelamarthySriram Rajan
Mar 5, 2011·Spine·Casey H HalpernSherman C Stein
Dec 5, 2013·Spine·Alexander A TheologisMurat Pekmezci
Jul 15, 2020·Der Unfallchirurg·Philipp SchleicherFrank Kandziora
Mar 30, 2013·Neurosurgery·Timothy C RykenNicholas Theodore
May 12, 2012·CJEM·Brian E GrunauJeremy Hall
Apr 14, 2018·Neurocritical Care·Christopher D ShankMark N Hadley
Oct 21, 2016·Neurosurgery·Lubdha M Shah, Jeffrey S Ross
Mar 15, 2018·Advances in Orthopedics·Kivanc AtesokSteven Theiss
Sep 17, 2021·Der Unfallchirurg·Philipp SchleicherFrank Kandziora

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.