Session VI - Spine


Fri., 10/6/06 Pediatrics & Spine, Paper #31, 11:50 am

Cervical Dynamic Screening in Spinal Clearance Now Redundant?

Rohit Kotnis, MRCS1 (n); Veronique Spiteri, MRCS2 (n);
Rihab Elzein, MBBS1 (n); Rachala Madhu, MRCS1 (n);
Adam Brooks, FRCS3 (n); Parminder Singh, MRCS1 (n);
Keith Willett, FRCS1 (n);
1John Radcliffe Hospital, Headington, Oxford, United Kingdom;
2Northampton General Hospital, Northampton, United Kingdom;
3Great Western Hospital, Swindon, United Kingdom

Background: The safest and most effective method of early spine clearance in unconscious patients is the subject of intense debate.

Hypothesis: Helical CT is a sufficiently sensitive investigation to render dynamic screening of the cervical spine redundant.

Protocol: Our protocol for cervical spinal clearance in the unconscious patient since April 1994 involves the use of plain radiographs, CT scan, and dynamic screening (DS).

Method: Over a 10-year period, April 1994 to September 2004, 839 patients were admitted to intensive care under the orthopaedic surgeons. 35 patients were excluded because of incomplete records.

Results: Demographics: The mechanism of injury was a road traffic accident in 80% and the mean ISS was 24.1. There were 95 patients (11.8%) with a cervical spine fracture, 96 (11.9%) with a fracture in either/both thoracic and lumbar regions.

Spine clearance: The mean intubation period was 7.1 days with a mean time to spine clearance of 0.4 days. In 318 patients, clearance was performed with the patient conscious (284 prior to intubation, 34 after intubation of <24hrs). 42 patients (5.2%) died before spine clearance. In 10 patients, the protocol was not followed.

Inclusions: 434 patients underwent CT. 10 of the 95 cervical fractures were deemed stable and underwent DS (n = 349).

Missed Cases: CT missed 2 cases of instability; one of these (an atlanto-occipital dislocation) was also missed by DS. Critical analysis revealed that a Powers ratio calculation would have diagnosed this injury on CT. The sensitivity of CT was 97.7% and for DS, 98.8%. The specificity for both CT and DS was 100%. There were no complications from either procedure.

Conclusion: DS is a safe procedure but has no real advantage over helical CT. Powers 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.


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· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.