Limitation of the cross table lateral view in detecting cervical spine injuries: A retrospective analysis

Shaffer, Mark A.; Doris, Peter E.

doi:10.1016/s0196-0644(81)80004-2

Cited by 107 publications

(20 citation statements)

References 4 publications

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“…Several units performed only a lateral cervical spine film. This has been reported as having a sensitivity of 83% [13][14][15] and is commonly technically inadequate, requiring repeat films and additional views if the cervico-thoracic junction is to be visualised [10,[14][15][16]. A three-view series (lateral, anteroposterior and odontoid peg) is reportedly more sensitive [13][14][15]17], though in unconscious patients the presence of a tracheal tube makes these films difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK*

2004

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SummaryA postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion-extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries.

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Section: Discussionmentioning

confidence: 99%

Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK*

2004

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“…An anatomically and technically adequate film will visualise the cervical spine from the craniocervical junction (occipito-atlantal articulation) to the cervicothoracic junction, with adequate penetration to see all vertebral bony structures and soft tissue relations. If anatomically and technically adequate, the lateral plain film sensitivity is high when interpreted by an expert with 73.4-89.7% of cervical injuries being detected [8,92,[98][99][100] but, conversely, this view will therefore miss approximately 15% of cervical spine injuries. In addition, it has been estimated that 10-20% of missed injuries result from the misinterpretation of suboptimal radiographs, particularly when performed in the emergency department [101].…”

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confidence: 99%

“…[8,92,[98][99][100] but, conversely, this view will therefore miss approximately 15% of cervical spine injuries. In addition, it has been estimated that 10-20% of missed injuries result from the misinterpretation of suboptimal radiographs, particularly when performed in the emergency department [101].…”

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confidence: 99%

“…In a recent UK survey of intensive care units, 48% of respondents were satisfied to clear the cervical spine while patients were unconscious and unable to provide clinical clues [115], and in published studies, 12-95% of clinicians have been confident in excluding injury with this view alone [12,98,116]. While the prevalence of this practice may vary, with a sensitivity of only 85% among an unconscious polytrauma population with a > 10% prevalence of cervical spine injury, missing at least 1.5% of injuries is unacceptable.…”

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confidence: 99%

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Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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“…A cross-table lateral cervical (CTLC) film may show normality in 5% to 15% of the patients who indeed have cervical spine injuries. [1][2][3] On the other hand, computed tomographic (CT) scans of the cervical spine have been shown to be more sensitive in identifying cervical spine injuries. 4,5 Thus, recent guidelines suggest that the plain radiograph followed by focused CT scanning through suspicious and inadequately visualised areas is a sufficient screening tool.…”

Section: Introductionmentioning

confidence: 99%

How Often Should Computed Tomographic Scans following Cross-Table Lateral Cervical Films Be Performed?

Suzuki¹,

Morimura²,

Sugiyama

et al. 2004

J Orthop Surg (Hong Kong)

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tebra visualised on the CTLC film. The frequency of abnormal signs on the CTLC films was then examined. Results. Technically adequate CTLC films that showed the upper border of the T1 vertebra were not obtained from 70 patients with injuries and 63 patients without injuries. 88 patients with injuries and 28 patients without injuries had abnormal findings on CTLC films. Overall, 97 patients with injuries and 74 patients without injuries should have received supplemental CT scans. Conclusion. CTLC films require frequent supplemental use of CT, even for patients without cervical spine injuries. Thus, the guidelines that consider CTLC film as an indicator of the necessity for CT scanning are not efficient and need revision. ABSTRACTPurpose. In patients with blunt trauma, a crosstable lateral cervical (CTLC) film is followed by a focused computed tomographic (CT) scan of the cervical spine to assess an area inadequately delineated by common techniques and suspected injuries, based on recent guidelines in the United States. The purpose of this study was to calculate the frequency of such supplemental CT scans and to evaluate the efficacy of the recent guidelines describing the use of CTLC films as an indicator of supplemental focused CT scanning in Japan. Methods. A review of CTLC films was performed. 100 initial CTLC films with injuries and another 100 films without injuries were evaluated for the lowest ver-

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Limitation of the cross table lateral view in detecting cervical spine injuries: A retrospective analysis

Cited by 107 publications

References 4 publications

Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK*

Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK*

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

How Often Should Computed Tomographic Scans following Cross-Table Lateral Cervical Films Be Performed?

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