The majority of intoxicated patients with a possible cervical spine injury remain in a cervical collar or undergo magnetic resonance imaging (MRI). This approach is preferred since computed tomography (CT) exams alone are insensitive for detecting ligamentous injuries. A study was conducted to assess rates of spinal injuries that are overlooked by CT scans. This study took place in a level 1 trauma center evaluating 1,668 patients over the course of one year. Board-certified radiologist interpreted the CT scans which were performed with 2-mm slice thickness.
The results found that 632 patients were intoxicated and of those, 157 had a minimum of one cervical spine injury. A total of five injuries were missed by the CT scan. Four of those patients had central cord syndrome while the other had an injury to the anterior longitudinal ligament and required surgical stabilization. These injuries were identified clinically with neurological deficits. For all injuries, CT presented a negative predictive value (NPV) of 99.2% and CT scan had a 98% NPV for unstable injuries. If a patient has a normal CT scan of the C-spine and has no neurological deficits, delayed flexion-extension films are no longer necessary to clear the cervical spine.
- Bush L et al. Evaluation of cervical spine clearance by computed tomographic scan alone in intoxicated patients with blunt trauma. JAMA Surg 2016 Jun 15; [e-pub]. (http://dx.doi.org/10.1001/jamasurg.2016.1248)