Abstract
Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt trauma who undergo imaging studies. However, timely and accurate recognition of cervical spine injury is essential for the optimal management of patients with blunt trauma as subsequent morbidity includes prolonged immobilization. Evaluation of cervical spine injuries should begin in the emergency department and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons for definitive management. Knowing which patients are at highest risk for injuries will undoubtedly influence decisions on how aggressively to pursue a potential cervical spine injury and can be achieved by establishing a multidisciplinary team approach that provides cervical spine immobilization, assessment, and clearance. Implementation of such guidelines will decrease time for cervical spine clearance and incidence of missed injuries. In this article different aspects of cervical spine injuries and cervical spine clearance protocols are reviewed.
Highlights
Imaging the cervical spine in blunt trauma has been controversial
And accurate recognition of cervical spine injury is essential to the optimal management of patients with blunt trauma as subsequent morbidity may cause prolonged immobilization.[2]
Knowing which patients are at highest risk for injuries will undoubtedly influence decisions on how aggressively to pursue a potential cervical spine injury, no published studies have yet identified the relative risks of injury to the cervical spine in different patient groups
Summary
Imaging the cervical spine in blunt trauma has been controversial. The debate has been dominated by the problem of ruling out a spinal injury in the unconscious trauma patient. There have been several reports of spinal instability despite normal radiographs, but maintaining immobilization on the intensive care unit ‘just in case’ has been associated with significant morbidity. New imaging techniques have become available, but did not solve the problem, adding their own ‘baggage’, such as cost, availability, logistic difficulties, radiation dosage, lack of specificity and evidence of effectiveness or safety.[1] Timely and accurate recognition of cervical spine injury is essential to the optimal management of patients with blunt trauma as subsequent morbidity may cause prolonged immobilization.[2]. The spectrum of cases seen in such studies may not represent the patterns of patients or injuries seen in most emergency departments.[5,6,7]
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