Cervical dynamic screening in spinal clearance: now redundant.
Spiteri V., Kotnis R., Singh P., Elzein R., Madhu R., Brooks A., Willett K.
BACKGROUND: The safest and most effective method of early cervical spine clearance in unconscious patients is the subject of intense debate. We hypothesize that helical computed tomography (CT) is a sufficiently sensitive investigation to render dynamic screening redundant. METHOD: We retrospectively reviewed the records of 839 trauma patients admitted to the intensive care unit under the orthopedic surgeons from April 1994 to September 2004. Our protocol for cervical spinal clearance in the unconscious patient involves plain radiographs, CT scanning, and dynamic screening. We recorded the presence of any unstable cervical spine injury and any cases that were missed by CT but detected by dynamic screening. RESULTS: There were 87 patients with an unstable cervical spine. Of these, 85 were detected by CT. Two cases were missed by CT (sensitivity 97.7%, specificity 100%). In one of these patients, dynamic screening detected an unstable spine and in the other patient dynamic screening missed an atlanto-occipital dislocation (sensitivity 98.8%, specificity 100%). Critical analysis of this case revealed that a powers ratio calculation on the CT scan would have detected the injury. There were no complications as a result of dynamic screening. CONCLUSION: Dynamic screening is a safe procedure but has no real advantage over helical CT. Power's 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.