Neurologic Deterioration Secondary to Unrecognized Spinal Instability Following Trauma–A Multicenter Study

Abstract

This multicenter study establishes that missed spinal injuries resulting in a neurologic deficit continue to occur in major trauma centers despite the presence of experienced personnel and sophisticated imaging techniques. Older age, high impact accidents, and patients with insufficient imaging are at highest risk.

Cervical Collars are Insufficient for Immobilizing an Unstable Cervical Spine Injury

“…Even when computer tomography and magnetic resonance imaging are used, a small number of patients will have an instability that is not recognized. Levi and coworkers conducted a retrospective review of 24 patients from eight level-I trauma centers who had an adverse neurologic outcome from a missed injury ''despite the presence of experienced personnel and sophisticated imaging techniques'' (22). For this reason, the use of cervical collars is mandated as part of the Advanced Trauma Life Support protocol, as well as others.…”

Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review

“…In one large, multi-center study, missed CSI presenting with a neurological deficit occurred in less than 1 of 500 spine injury cases and 1 of 4000 trauma cases, with an average delay in diagnosis of approximately 20 days. 86 On one hand, there are studies where up to 8% of necks were not immobilized, seemingly without clinical consequences or progress to neurological deficits. [87][88][89][90][91] Conversely, Gerrelts and colleagues identified the development of temporary neurological symptoms before treatment, but were unable to identify permanent complications in those with missed cervical fractures.…”

Unrecognized ligamentous instability due to high-energy, low-velocity mechanism of injury

“…11,12 The incidence of missed spinal fracture after trauma is estimated to be between 0.001% and 4.6%. 3,13,14 Purely ligamentous injuries represent 10% of all injuries to the C-spine. 1 Despite its relatively low incidence, purely ligamentous injury to the C-spine is a well-recognized concern due to the potentially catastrophic consequences of misdiagnosis.…”

“…[1][2][3] As a result, there is limited evidence available to aid clinicians in determining the high-risk mechanisms of injury and the ''at-risk" patient groups. Furthermore, there is no consensus on the optimal method for clearing the C-spine to be free of injury.…”