Balloon angioplasty catheters for endovascular tamponade after vascular trauma

Abstract

Ross et al. (1987) performed a prospective study comparing the sensitivity and selectivity of various methods of initial radiological evaluation of the cervical spine. They concluded that a technically adequate three-view cervical spine series (later, anteroposterior and open-mouth odontoid films) can be used safely to eliminate instability. However, following this protocol in our patients still allowed us to miss the pathology. We would therefore suggest adding stress views (in flexion and extension) to the series when there is any suspicion of a high-energy injury. In situations where adequate stress views are impossible to obtain because of insufficient excursion due to painful muscle spasm, the patient should be seen again for further assessment and radiographs. This is in agreement with Herkowitz and Rothman (1984) who propose that a complete follow-up evaluation should be performed in every case of cervical injury. This should include a complete radiological examination, including stress films. The Accident and Emergency Department at the Royal Liverpool University Hospital sees over 5000 patients a month and of these approximately 100 require cervical spine radiography for trauma. The financial implications of this proposed management are obviously significant, but we believe they are easily justified when one considers the alternative, i.e. the economic burden of caring for a patient with permanent paralysis. Acknowledgements We would like to thank Mr J. C. Dorgan for allowing us to report on one of his patients, and also Professor L. Klenerman for help and advice in the preparation of this paper.