Cervical spine clearance has typically required us to address both bones and ligaments. For a long time, this has involved separate steps: imaging for the bones, and exam (or additional imaging) for the ligaments. But this extra step adds complexity and seems to have a low yield.
The number of studies supporting use of only CT to clear both bones and ligaments continues to increase. A poster being presented this week at EAST details the experience with this at Virginia Commonwealth University. They looked at all their blunt trauma patients over a 5 year period. They detailed all fractures, ligamentous injuries, and how they were discovered.
Here are the factoids:
- A total of 5676 patients were entered in the study
- 420 (7%) were diagnosed with cervical fracture
- 53 (1%) had a ligamentous injury
- Of the ligamentous injuries, 21 of 53 were suspected based on the CT. The remaining 32 all had fractures in addition to the ligamentous injury.
Bottom line: Yes, it’s small and retrospective, but it continues to paint the same picture as the other papers. The authors conclude that CT alone is sufficient to clear both bones and ligaments. I presume this excludes the group that can be cleared clinically. Adopting this process will streamline the clearance process, and help avoid complications like pressure sores. What about missed injuries? There will always be a few. We are currently at a point of diminishing returns in terms of how much diagnostic radiation, magnetism, and money we throw at this problem. But the key to successfully and safely implementing this is to make sure to have the most experienced clinicians reading the images.
Reference: CT scan: it’s not just about the fracture. EAST 2014, poster #35.