- Paper Report
- Open Access
C-spine examination with dynamic fluoroscopy
- Arpan Guha1
© Biomed Central Ltd 2001
- Received: 2 August 2001
- Published: 4 December 2001
- head Injury
- spinal injuries
Classical trauma guidelines recommend cervical spine (C-spine) X-rays to rule out bone injury. However, injuries not involving bone, such as ligamentous or spinal cord injuries without radiological abnormality, can still occur with 'normal' C-spine X-rays. Therefore a hard collar should be fitted to the neck and the C-spine immobilized until the patient regains consciousness and neck tenderness, which implies actual C-spine injury, can be assessed. However, many patients require prolonged ventilation and sedation in an ICU, which does not allow for such assessments to be carried out. Recommendations have ranged from removing the cervical collar to indefinite immobilization of the C-spine. This study aims to evaluate the value of dynamic fluoroscopic examinations of the C-spine in patients with head injury to determine the presence of ligamentous abnormalities.
Dynamic fluoroscopy of 301 trauma patients revealed 297 true negative, 2 true positive, 1 false positive and 1 false negative results. The true positives were treated and later discharged from the ICU. In the false positive patient, CT and MRI scans ruled out any ligament damage. In the false negative patient the initial C-spine X-rays had been misinterpreted and dynamic fluoroscopy was carried out without visualising the entire C-spine (i.e. C0-T1); the patient was rendered quadriplegic after removal of the cervical collar.
Due to its inherent risks, dynamic fluoroscopy must adhere to strict protocols. X-rays of the entire C-spine must be examined by a senior radiologist, who then directs the fluoroscopic examination assisted by ICU personnel. Unstable ligamentous C-spine injury is rare in the absence of vertebral fracture and in this study there was an incidence of 0.7%. The C-spine may be considered clear after adequate plain X-rays supplemented with CT scan if required.
301 patients with closed heady injury, dynamic fluoroscopic examination of cervical spine.