Pavan Khanna MD, Presenter: Nothing to Disclose

David B. Douglas MD, Abstract Co-Author: Nothing to Disclose

Matthew Bobinski MD, PhD, Abstract Co-Author: Nothing to Disclose

Traditionally, Flexion/Extension (F/E) radiographs have been performed to evaluate for instability of the cervical spine in the setting of trauma.  At our Level 1 Trauma Center, F/E is commonly performed after CT and MRI. However, F/E radiographs in the setting of both CT and MRI has not been studied in large scale. The purpose of this study is to evaluate our institution’s data to determine the utility of F/E radiographs in the setting of both normal and abnormal CT and MRI. We hypothesize that there is no added benefit of supplementing evaluation of the blunt trauma patient with F/E radiographs in the presence of normal and abnormal cross sectional imaging of the cervical spine.

We have reviewed five consecutive years of data from 17,000 patients evaluated at our level I trauma center. Our inclusion criteria includes patients who suffered blunt trauma and underwent CT, MRI and F/E radiographs of the cervical spine within a 3 day period. Additionally, we have recently expanded our database to include patients from 2009-2010, using the aforementioned criteria.

Out of the patients that met our inclusion criteria, 71% of patients had a normal CT and MRI; all of these patients had negative F/E radiographs. 26 % of patients had a normal CT and positive findings on MRI; out of these, only 9% of patients had positive findings on F/E radiographs. None of these positive F/E radiographs altered the management of the patients. There were no cases of positive CT with a negative MRI. Of the patients with positive findings on both CT and MRI, 66% had positive findings on F/E radiographs. Additional data from 2009-2010 will be reviewed and analyzed.  

In our institution, there were no cases of positive F/E radiographs in the presence of a normal cervical spine CT and MRI. This result was compatible with prior studies in the literature, which have examined the utility of F/E in comparison with CT or MRI. To our knowledge, no prior studies have compared CT, MRI and F/E in the setting of blunt trauma. It is our belief that there is little utility of F/E radiographs in the setting of normal and abnormal CT and MRI and adds little to the identification and characterization of cervical spine injury.  

Changing the protocol for evaluating traumatic cervical spine injuries will avoid unnecessary delays in patient care, additional potentially harmful radiation, and healthcare costs.

Khanna, P, Douglas, D, Bobinski, M, The Utility of Flexion and Extension Radiographs of the Cervical Spine in the Setting of Blunt Trauma.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013302.html