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The daunting task of "clearing" the cervical spine
Brian E Grunau1, Daniel Dibski, Jeremy Hall
1Emergency Department, St. Paul's Hospital, and Department of Emergency Medicine, University of British Columbia, Vancouver, BC. briangrunau@gmail.com
CJEM
|May 12, 2012
Summary
Computed tomography (CT) scans may miss severe cervical spine injuries, even with reconstructions. A case study highlights the need for further evaluation if neck pain persists after a negative CT scan.
Area of Science:
- Emergency medicine
- Radiology
- Orthopedic surgery
Background:
- Cervical spine evaluation in emergency departments is crucial but challenging.
- Traumatic injuries require prompt and accurate diagnosis.
Observation:
- A 70-year-old female presented with intoxication and a history of a fall.
- Initial 64-slice computed tomographic (CT) scan with reconstructions showed no acute injury.
- Persistent neck pain led to re-examination when the patient was alert.
Findings:
- Flexion-extension views revealed severe C5-C6 subluxation with jumped facets.
- Magnetic resonance imaging (MRI) confirmed significant ligamentous injury.
- CT scans, while sensitive, may not detect all severe cervical injuries.
Implications:
- Highlights potential limitations of CT in diagnosing subtle but severe cervical spine injuries.
- Emphasizes the importance of clinical reassessment and advanced imaging (MRI) when suspicion of injury remains.
- Suggests a need for careful consideration of diagnostic pathways for cervical trauma in intoxicated patients.
