Cervical Dynamic Screening in Spinal Clearance: Now Redundant

Abstract

Dynamic screening is a safe procedure but has no real advantage over helical CT. Power's ratio calculation is essential to reduce the chance of a missing an upper cervical injury. The cervical spine can be reliably cleared using helical CT alone.

MRI Is Unnecessary to Clear the Cervical Spine in Obtunded/Comatose Trauma Patients: The Four-Year Experience of a Level I Trauma Center

“…[12][13][14] Dynamic fluoroscopy in the obtunded patient has proved no superior to helical CT in uncovering C-spine instability and has recently been abandoned as redundant and unsafe. 15,16 The question of whether a form of unstable cervical injury exists that neither can be identified by radiologist-read modern helical CT with reconstructions nor engenders a detectable neurologic deficit but can be appreciated on the nondynamic C-spine MRI remains unanswered. A number of studies have tested the hypothesis that helical CT alone may be adequate to clear the C-spine in trauma patients.…”

Are computed tomography scans adequate in assessing cervical spine pain following blunt trauma?

“…A second reason may be related to the increased use of helical CT in emergency departments to image severely traumatised patients rapidly. During such scanning, the entire neuraxis can be rapidly and accurately interrogated, and thus dynamic radiographs may seem redundant 9 10. Spiteri et al showed comparable sensitivities and specificities for both diagnostic modalities and suggested that DS has no significant advantage over helical CT in detecting instability in obtunded patients.…”

Cervical spine clearance protocols in Level I, II, and III trauma centers in California

“…For example, in 2002, EAST recommended the use of passive flexion-extension fluoroscopy when clearing an obtunded patient. Since then, a number of studies reported the inadequacy, cost inefficiency, and safety concerns of this technique [3][4][5][6][7][8]. Thus, EAST updated their guidelines in 2009 to reflect these concerns and now recommends against the use of passive flexion-extension radiographs in obtunded patients [9].…”