#UNSTABLE CERVICAL SPINE FLEXION X RAY FULL#

When a patient has to be transported to another facility make sure that the patient has full immobilization with back board and head-side blocks with the collar and head secured to the side blocks. I prefer the Aspen or the Miami collar, they are very similar in function overall and superior to the pre-hospital EMS ones. What is available to you will be somewhat hospital - vendor specific. Depending on the exam and risk factors I would consider either a CTA or and MRA to evaluate for vascular injury. If your patient has a focal neurological complaint or deficit, a suspected ligamentous or disc injury an MRI should be done. Most patients without focal neurological complaint or deficit are imaged with plain CT. The cross table lateral films and specifically flexion/extension views have fallen out of favor. Sometimes the mild dementia, delirium or subtle drug, alcohol intoxication can lead us astray when we rely solely on these criteria.

However, a word of caution on using these criteria with patients who could be impaired. The National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-Spine Rule (CCR) have been validated and have allowed our practice to advance such that we can effectively practice clinical medicine. Recommendations for imaging the cervical spine for trauma has changed quit a lot over the last several years. Once the gear is removed a c-collar should then be applied and you can proceed with imaging. More recent thought is that cervical spine imaging should incorporate procedures for removal of equipment before initial radiographic evaluation. From personal experience it can be difficult to remove protective gear I recommend getting 'all hands on deck' and using an methodical slow organized approach. There are many opinions on how best to do this and whether an x-ray should be done before attempting the removal of protective gear. Eventually the protective devices are going to need to be removed. Moving to advanced imaging is especially important if there is a complaint of a focal neurological deficit be that transient, subjective or blatantly obvious.Īthletes or motorcyclist who have suspected cervical spine injury, who have protective shoulder pads and/or helmets pose a unique challenge. Any asymmetric finding should raise your level of suspicion for severe injury. I can not stress enough the importance of a detailed neurological exam including sensation(s) and reflexes. The mechanism of injury is something we always talk about, but when it comes to neck trauma we need to really pay attention to all available history including paramedic reports, or even cell phone video, to get the best possible picture or the mechanism of injury. Certain chronic disease states and anatomic variances, as you note, do put select patient populations at risk for specific injury. Knowing the factors that put people a high risk for injury is also paramount. It is important to have an understanding of the anatomy and this is a great review. You've done a really nice job in laying out the most salient points.

Unstable cervical spine flexion x ray