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Evaluating the Cervical Spine in the Blunt Trauma Patient

Schoenfeld, Andrew J. MD, MSc; Beck, Aaron W. MD; Harris, Mitchel B. MD; Anderson, Paul A. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: September 1, 2019 - Volume 27 - Issue 17 - p 633-641
doi: 10.5435/JAAOS-D-18-00695
Review Article

Following a blunt trauma, the goal of the cervical spine evaluation is to identify any injuries that might require active management: either through continued use of a collar or surgical stabilization. This is achieved through a step-wise approach that considers the nature of the patient's trauma, presenting complaints, distracting injuries and capacity to cooperate with the examination. In the last 15 to 20 years, technological advances in radiographic imaging have improved clinicians' abilities to certify the cervical spine as free of injury following blunt trauma. Within the last decade, the use of CT has supplanted plain radiograph imaging as the standard screening modality. Although MRI is more sensitive than CT in identifying occult cervical injury, particularly ligamentous or soft-tissue trauma, the standard addition of MRI to CT evaluation alone does not significantly increase the detection of clinically important cervical injuries.

From the Department of Orthopaedic Surgery (Dr. Schoenfeld and Dr. Beck), Brigham and Women's Hospital, Harvard Medical School, the Department of Orthopaedic Surgery (Dr. Harris), Massachusetts General Hospital, Harvard Medical School, Boston, MA, and the Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, Madison, WI (Dr. Anderson).

Dr. Schoenfeld receives funding outside this work from the National Institutes of Health-NIAMS, Department of Defense, OREF and Centers for Medicare and Medicaid Services. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Beck, Dr. Harris, and Dr. Anderson.

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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