| ABSTRACT: |
Flexion and extension lateral radiographs of
the cervical spine may suggest signs of ligamentous and soft tissue injuries
in a potentially unstable spine. However, patients with acute injuries and
severe pain and muscle spasms may not be able to move their necks effectively,
severely compromising the diagnostic yield of the radiographs. In addition,
there are reports of serious neurologic injuries occurring with the use
of these radiographs in acutely injured patients. The purpose of this study
was to determine the effectiveness and yield of obtaining cervical spine
flexion and extension radiographs in the emergency department on acutely
injured patients. Review of all patients with cervical flexion and extension
radiographs presenting to a Level 1 trauma center was performed. All radiographs
were judged based on the adequacy of flexion and extension movement and
positive findings indicative of instability by the radiologist in the emergency
room. The radiographs of one patient (0.34%) revealed positive findings
of instability. Of the 290 flexion and extension radiographs, 97 (33.5%)
of them showed such little or inadequate flexion or extension movement that
cervical stability could not be assessed. Flexion and extension cervical
radiographs should not be obtained routinely in the emergency department
because 1/3 of these studies will be inadequate because of pain and muscle
spasms experienced by patients. Patients with cervical injuries may not
be able to fully flex and extend their necks; this may lead to false reassurance
to patients who actually have had an inadequate study to diagnose potential
instability. |