Session IX - Spine

*Prospective Evaluation of Acute Cervical Spine Clearance in Unresponsive Trauma Patients

Clifford B. Jones, MD; Timothy D. Henne, MD; Wayne E. Vanderkolk, MD; Michigan State University, Grand Rapids, Michigan, USA (a-Zimmer, Inc.)

Purpose: We prospectively evaluated the results of occiput-C2 spinal CT imaging to assess the effectiveness of early clearance of potential cervical spine injuries in unresponsive trauma patients.

Methods: During a 1-year period at a level-1 trauma center, a prospective system was created to acutely diagnose cervical spine (c-spine) injuries in unresponsive patients. An unresponsive patient was defined as one with a traumatic brain injury with a Glasgow Coma Scale (GCS) score of less than 9. Eighty-three consecutive patients, 58 men and 25 women, met the initial criteria and were entered into the study. Inclusion criteria entailed injury from a blunt trauma mechanism and GCS <9. All c-spines were cleared acutely (<24 hours). Exclusion criteria included an incomplete c-spine series or GCS >9 at the time of collar removal (<24 hours). The traumatic brain injuries included skull fractures (N = 19, 2 open), subdural hematomas (N = 9), subarachnoid hematomas (N = 2), epidural hematomas (N = 2), intraparenchymal hematomas (N = 10), brain contusions (N = 4), and shear injuries (N = 1). The average number of associated injuries was 3 (range, 0 to 11). All patients underwent standard advanced trauma life support protocols. Initial lateral c-spine radiographs were obtained in the trauma bay. All patients had a complete c-spine radiographic series (AP, lateral, open-mouth, obliques, and swimmers, if needed). During CT imaging of the head, an additional occiput-C2 CT scan was obtained. Despite the inability to clinically evaluate an unresponsive patient, the c-collar was removed within 24 hours of admission if the results of all imaging studies were negative. All patients were followed for a minimum of 6 months.

Results: On the basis of the protocol, eight unresponsive patients (10%) were acutely diagnosed with c-spine injuries. Three of the eight patients (38%) had associated spinal cord injuries. The number of spinal injures per patient were one (N = 4), two (N = 3), and three (N = 1). No c-spine injuries were missed.

Discussion: Unresponsive patients frequently have brain CT imaging to evaluate intracranial pathology. It is not time-consuming to obtain a concomitant occiput-to-C2 CT scan. The combination of complete c-spine radiographs and occiput-to-C2 CT imaging is an effective method for acute evaluation of the presence of c-spine injuries in unresponsive trauma patients.