Flouroscopy in the Clearance of the Cervical Spine:

- Discussion:
                            - in the report by Davis et al 2001, the authors evaluated the efficacy and safety of dynamic fluoroscopy flexion-extension
                                    examinations in identifying ligamentous cervical spine injury and clearing the cervical spine in patients with altered
                                    mental status after trauma;
                            - protocol required visualization of the entire cervical spine, through T1, through full extension and flexion under the direct supervision of a radiologist;
                            - oblique fluoroscopic views were obtained, as necessary, to visualize the cervicothoracic junction.
                            - fluoroscopic examinations were performed on 301 patients;
                            - there were 297 true-negative examinations, 2 true-positive examinations (stable injuries), 1 false-negative examination, and
                                    1 false-positive examination;
                            - incidence of ligamentous injury identified by fluoroscopy in this study was 2 of 301 (0.7%);
                            - unstable cervical spine ligamentous injuries were identified in only 0.02% of all trauma patients;
                            - one patient developed quadriplegia when fluoroscopic evaluation was performed after two protocol violations;
                            - unstable cervical spine ligamentous injury without fracture is a rare occurrence;
                    - references:
                            - Discontinuation of C. spine immobilisation in unconscious patients with trauma in intensive care units: telephone survey in south and west region.
                                    Gupta KJ, Clancy M. BMJ. 1997; 314: 1652-1655.
                             - Routine Evaluation of the C Spine in Head-Injured Patients with Dynamic Fluoroscopy: A Reappraisal. Davis J. of Trauma 2001;50:1044-1047
                             - Clearing, the cervical spine in obtunded patients: the use of dynamic fluoroscopy.  Davis JW. J Trauma. 1995; 39: 435-438.
                             - Fluoroscopically Guided Passive Flexion-Extension Views of the Cervical Spine in the Obtunded Blunt Trauma Patient: A Commentary
                                     Stuart E. Mirvis, MD, FACR. Journal of Trauma. 2001;50:868-870
                             - Evaluation of the Oxford protocol for total spinal clearance in the unconscious trauma patient.
                                     Brooks RA, Willett KM. J Trauma. 2001; 50: 862-867.
                             - C. spine evaluation in obtunded or comatose pediatric trauma patients: a pilot study. Scarrow AM, Pediatr Neurosurg. 1999;30:169-