Skip to main content

Cervical Spine Clearance

  • Chapter
  • First Online:
Book cover Orthopedic Traumatology

Abstract

GB is a 25-year-old male who presents after an all terrain vehicle (ATV) accident. At the scene the patient demonstrates a GCS score of 12 complaining of chest pain and is placed in a cervical collar. The patient presents to the local emergency room via EMS. On primary survey the patient demonstrates a flail chest and is hemodynamically unstable. In the trauma bay the patient is intubated and stabilized hemodynamically. His CXR demonstrates multiple rib fractures and a hemothorax. A left-sided chest tube is placed. Secondary survey is negative.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McCaig LF, Ly N. National Hospital Ambulatory Medical Care Survey: 2000 emergency department summary. Advance data from vital and health statistics. No. 326. Hyattsville, Md.: National Center for Health Statistics, 2002. (DHHS publication no. (PHS) 2002-1250 02-0259.)

    Google Scholar 

  2. Roberge RJ, Wears RC. Evaluation of neck discomfort, neck tenderness, and neurologic deficits as indicators for radiography in blunt trauma victims. J Emerg Med. 1992;10:539–44.

    Article  PubMed  CAS  Google Scholar 

  3. Marshall LF, Knowlton S, Garfin SR, et al. Deterioration following spinal cord injury. A multicenter study. J Neurosurg. 1987;66:400–4.

    Article  PubMed  CAS  Google Scholar 

  4. Morris CG, McCoy E. Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening. Anaesthesia. 2004;59:464–82.

    Article  PubMed  CAS  Google Scholar 

  5. American College of Surgeons: American College of Surgeons Committee on Trauma. Advanced trauma life support: ATLS. 7th ed. Chicago, IL: American College of Surgeons; 2004.

    Google Scholar 

  6. ASIA. Standards for neurological classification of spinal injury. Chicago: American Spinal Injury Association; 1996.

    Google Scholar 

  7. Stauffer ES. Neurologic recovery following injuries to the cervical spinal cord and nerve roots. Spine. 1984;9:532–4.

    Article  PubMed  CAS  Google Scholar 

  8. Kiwerski J, Weiss M. Neurological improvement in traumatic injuries of cervical spinal cord. Paraplegia. 1981;19:31–7.

    Article  PubMed  CAS  Google Scholar 

  9. Duane TM, Dechert T, Wolfe LG, et al. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma. 2007;62:1405–8.

    Article  PubMed  Google Scholar 

  10. Gonzalez RP, Fried PO, Bukhalo M, et al. Role of clinical examination in screening for blunt cervical spine injury. J Am Coll Surg. 1999;189:152–7.

    Article  PubMed  CAS  Google Scholar 

  11. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349:2510–8.

    Article  PubMed  CAS  Google Scholar 

  12. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma: National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.

    Article  PubMed  CAS  Google Scholar 

  13. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–8.

    Article  PubMed  CAS  Google Scholar 

  14. Tontz W, Anderson PA, Resnick DK. Clearance of the asymptomatic cervical spine: a meta-analysis. Spine J. 2006;6:60S.

    Article  Google Scholar 

  15. Daffner RH, Hackney DB. ACR appropriateness criteria on suspected spine trauma. J Am Coll Radiol. 2007;4:762–75.

    Article  PubMed  Google Scholar 

  16. Hadley MN. Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery. 2002;50(3 suppl):S30–5.

    Google Scholar 

  17. France JC. Update on the appropriate radiographic studies for cervical spine Evaluation and clearance in the polytraumatized patient. Curr Orthop Pract. 2008;19:411–5.

    Article  Google Scholar 

  18. Milby AH, Halpern CH, Guo W, et al. Prevalence of cervical spinal injury in trauma. Neurosurg Focus. 2008;25:E10.

    Article  PubMed  Google Scholar 

  19. Menaker J, Philp A, Boswell S, et al. Computed tomography alone for cervical spine clearance in the unreliable patient: are we there yet? J Trauma. 2008;64:898–903.

    Article  PubMed  Google Scholar 

  20. Muchow RD, Resnick DK, Abdel MP, et al. Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis. J Trauma. 2008;64:179–89.

    Article  PubMed  Google Scholar 

  21. Stassen NA, Williams VA, Gestring ML, et al. Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. J Trauma. 2006;60:171–7.

    Article  PubMed  Google Scholar 

  22. Grossman MD, Reilly PM, Gillett T, et al. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma. 1999;47:684–90.

    Article  PubMed  CAS  Google Scholar 

  23. Burrney RE, Maio RF, Maynard F, et al. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America. Arch Surg. 1993;128:596–9.

    Article  Google Scholar 

  24. Blackmore CC, Emerson SS, Mann FA, et al. Cervical spine imaging in patients with trauma: determination of fracture risk to optimize use. Radiology. 1999;211:759–65.

    PubMed  CAS  Google Scholar 

  25. Parsons KC. The impact of spinal cord injury on long term survival. J Insur Med. 1991;23:227.

    PubMed  CAS  Google Scholar 

  26. Parsons KC, Lammertse DP. Rehabilitation in spinal cord disorders. 1. Epidemiology, prevention, and system of care of spinal disorders. Arch Phys Med Rehabil. 1991;72:S293–294.

    PubMed  CAS  Google Scholar 

  27. Anderson PA, Muchow RD, Munoz A, et al. Clearance of the asymptomatic cervical spine: a meta-analysis. J Orthop Trauma. 2010;24:100–6.

    Article  PubMed  Google Scholar 

  28. 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;21:1454–60.

    Article  PubMed  CAS  Google Scholar 

  29. Mahadevan S, Mower WR, Hoffman JR, et al. Interrater reliability of cervical spine injury criteria in patients with blunt trauma. Ann Emerg Med. 1998;31:197–201.

    Article  PubMed  CAS  Google Scholar 

  30. Hoffman JR, Wolfson AB, Todd K, et al. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998;32:461–9.

    Article  PubMed  CAS  Google Scholar 

  31. Bandiera G, Stiell IG, Wells GA, et al. The Canadian C-Spine Rule performs better than unstructures physician judgement. Ann Emerg Med. 2003;42:395–402.

    Article  PubMed  Google Scholar 

  32. Stiell IG, Wells GA, McKnight RD, et al. Canadian C-Spine Rule study for alert and stable trauma patients. I. Background and rationale. Can J Emerg Med. 2002;4:84–90.

    Google Scholar 

  33. Idem. Canadian C-Spine Rule study for alert and stable trauma patients. II. Study objectives and methodology. Can J Emerg Med. 2002;4:185–93.

    Google Scholar 

  34. Como JJ, Diaz JJ, Dunham CM, et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma. 2009;67:651–9.

    Article  PubMed  Google Scholar 

  35. Harris MB, Sethi RK. The initial assessment and management of the multiple-trauma patient with an associated spine injury. Spine (Phila Pa 1976). 2006;31(11 suppl):S9–S15.

    Article  Google Scholar 

  36. Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a metaanalysis. J Trauma. 2005;58:902–5.

    Article  PubMed  Google Scholar 

  37. Gale SC, Gracias VH, Reilly PM, et al. The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. J Trauma. 2005;59:1121–5.

    Article  PubMed  Google Scholar 

  38. Bachulis BL, Long WB, Hynes GD, et al. Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg. 1987;153:473–8.

    Article  PubMed  CAS  Google Scholar 

  39. Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002;50:S36–S43.

    Google Scholar 

  40. MacDonald RL, Schwartz ML, Mirich D, et al. Diagnosis of cervical spine injury in motor vehicle crash victims: how many X-rays are enough? J Trauma. 1990;30:392–7.

    PubMed  CAS  Google Scholar 

  41. Brown CV, Antevil JL, Sise MJ, et al. Spiral computed tomography for the diagnosis of cervical, thoracic, and lumbar spine fractures: its time has come. J Trauma. 2005;58:890–5.

    Article  PubMed  Google Scholar 

  42. Hennessy D, Widder S, Zygun D, et al. Cervical spine clearance in obtunded blunt trauma patients: a prospective study. J Trauma. 2010;68:576–82.

    Article  PubMed  Google Scholar 

  43. McCulloch PT, France J, Jones DL, et al. Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high energy trauma. J Bone Joint Surg Am. 2005;87:2388–94.

    Article  PubMed  Google Scholar 

  44. Grogan EL, Morris Jr JA, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg. 2005;200:160–5.

    Article  PubMed  Google Scholar 

  45. Khan SN, Erickson G, Sena MJ, Gupta MC. Use of flexion and extension radiographs of the cervical spine to rule out acute instability in patients with negative computed tomography scans. J Orthop Trauma. 2011;1:51–6.

    Article  Google Scholar 

  46. Wadhwa R, Shamieh S, Haydel J, et al. The role of flexion and extension computed tomography with reconstruction in clearing the cervical spine in trauma patients: a pilot study. J Neurosurg Spine. 2011;14:341–7.

    Article  PubMed  Google Scholar 

  47. Vaccaro AR, Kreidl KO, Pan W, et al. Usefulness of MRI in isolated upper cervical spine fractures in adults. J Spinal Disord. 1998;11:289–93.

    PubMed  CAS  Google Scholar 

  48. Chiu WC, Haan JM, Cushing BM, et al. Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: incidence, evaluation, and outcome. J Trauma. 2001;50:457–63.

    Article  PubMed  CAS  Google Scholar 

  49. Chiu WC, Haan JM, Cushing BM, et al. Ligamentous injuries of the cervical spine in unreliable blunt trauma patients: incidence, evaluation, and outcome. J Trauma. 2001;50:457–63. discussion 464.

    Article  PubMed  CAS  Google Scholar 

  50. Iida H, Tachibana S, Kitahara T, et al. Association of head trauma with cervical spine injury, spinal cord injury, or both. J Trauma. 1999;46:450–2.

    Article  PubMed  CAS  Google Scholar 

  51. Webber-Jones JE, Thomas CA, Bordeaux Jr RE. The management and prevention of rigid cervical collar complications. Orthop Nurs. 2002;21:19–25.

    Article  PubMed  Google Scholar 

  52. Laylock B. Solving the problem of pressure ulcers resulting from cervical collars. Ostomy Wound Manage. 1996;42:26–8. 30, 32–3.

    Google Scholar 

  53. Liew SC, Hill DA. Complication of hard cervical collars in multi-trauma patients. Aust N Z J Surg. 1994;64:139–40.

    Article  PubMed  CAS  Google Scholar 

  54. Powers JA. Multidisciplinary approach to occipital pressure ulcers related to cervical collars. J Nurs Care Qual. 1997;12:46–52.

    Article  PubMed  CAS  Google Scholar 

  55. Watts D, Abrahams E, MacMillan C, et al. Insult after injury: pressure ulcers in trauma patients. Orthop Nurs. 1998;17:84–91.

    Article  PubMed  CAS  Google Scholar 

  56. Papadopoulos MC, Chakraborty A, Waldron G, et al. Lesson of the week: exacerbating cervical spine injury by applying a hard collar. BMJ. 1999;319:171–2.

    Article  PubMed  CAS  Google Scholar 

  57. Ho AM, Fung KY, Joynt GM, et al. Rigid cervical collar and intracranial pressure of patients with severe head injury. J Trauma. 2002;53:1185–8.

    Article  PubMed  Google Scholar 

  58. Horodyski M, Dipaola CP, Conrad BP, et al. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41:513–9.

    Article  PubMed  Google Scholar 

  59. Harris TJ, Blackmore CC, Mirza SK, et al. Clearing the cervical spine in obtunded patients. Spine. 2008;33:1547–53.

    Article  PubMed  Google Scholar 

  60. Hogan GJ, Mirvis SE, Shanmuganathan K, Scalea TM. Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal? Radiology. 2005;237:106–13.

    Article  PubMed  Google Scholar 

  61. Tomycz ND, Chew BG, Chang YF, et al. MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: the four-year experience of a level I trauma center. J Trauma. 2008;64:1258–63.

    Article  PubMed  Google Scholar 

  62. Simon JB, Schoenfeld AJ, Ketz JN, et al. Are “normal” multidetector computed tomographic scans sufficient to allow collar removal in the trauma patient? J Trauma. 2010;68:103–8.

    Article  PubMed  Google Scholar 

  63. Menaker J, Philp A, Boswell S, Scalea TM. Computed tomography alone for cervical spine clearance in the unreliable patient: are we there yet? J Trauma. 2008;64:898–903.

    Article  PubMed  Google Scholar 

  64. Bolinger B, Shartz M, Marion D. Bedside fluoroscopic flexion and extension cervical spine radiographs for clearance of the cervical spine in comatose trauma patients. J Trauma. 2004;56:132–6.

    Article  PubMed  Google Scholar 

  65. Spiteri V, Kotnis R, Singh P, et al. Cervical dynamic screening in spinal clearance: now redundant. J Trauma. 2006;61:1171–7.

    Article  PubMed  Google Scholar 

  66. Anglen J, Metzler M, Bunn P, et al. Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients. J Trauma. 2002;52:54–9.

    Article  PubMed  Google Scholar 

  67. Cox MW, McCarthy M, Lemmon G, et al. Cervical spine instability: clearance using dynamic fluoroscopy. Curr Surg. 2001;58:96–100.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andrew K. Simpson M.D., M.H.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Simpson, A.K., Harris, M.B. (2013). Cervical Spine Clearance. In: Sethi, M., Jahangir, A., Obremskey, W. (eds) Orthopedic Traumatology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3511-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-3511-2_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-3510-5

  • Online ISBN: 978-1-4614-3511-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics