title: Flexion-extension views in the evaluation of cervical-spine injuries.
abstract: OBJECTIVE
  To determine the efficacy of flexion-extension (F/E) cervical-spine radiographs in detecting acute cervical-spine instability in emergency patients.
  
  
  METHODS
  We retrospectively reviewed the charts of 141 consecutive trauma patients who had F/E views performed after a routine cervical-spine series (three views) was obtained in the emergency department. Interpretations of the routine series were compared with those of the F/E views to determine if additional useful information was provided by the latter. The charts also were reviewed to determine if any variables were associated with an increased use of F/E views, an increased likelihood of these views demonstrating instability, or any neurologic sequelae resulted from these studies.
  
  
  METHODS
  An urban Level I adult trauma center.
  
  
  METHODS
  The interpretations of the routine series were noted to be either normal, abnormal but without demonstrable fracture/dislocation, or demonstrating a fracture/dislocation. The F/E views were categorized as stable, unstable, or uninterpretable.
  
  
  RESULTS
  Cervical-spine instability was demonstrated by F/E views in 11 of the 141 patients (8%), four of whom had normal routine cervical-spine films. Three of these four patients required surgical stabilization. Prolonged neck pain (more than 24 hours), an initially abnormal spine series, and a neurosurgical consult were all associated with an increased use of F/E views. Ten of 11 patients with radiographic instability had significant neck pain by history; the remaining patient was intoxicated. No neurologic sequelae resulted from performing F/E studies. There was one false-negative F/E study, which raises concern about the reliability of this procedure in the ED.
  
  
  CONCLUSIONS
  We believe that a large prospective study is required to determine which patients warrant F/E views.
authors.affiliation: Emergency/Trauma Division, St Louis University Hospital, Missouri 63110-0250.
authors.forename: L M
authors.initials: LM
authors.lastname: Lewis
authors.forename: M
authors.initials: M
authors.lastname: Docherty
authors.forename: B E
authors.initials: BE
authors.lastname: Ruoff
authors.forename: J P
authors.initials: JP
authors.lastname: Fortney
authors.forename: R A
authors.initials: RA
authors.lastname: Keltner
authors.forename: P
authors.initials: P
authors.lastname: Britton
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D004630:Emergencies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging; D007593:Joint Instability / Q000000981:diagnostic imaging; D009068:Movement; D010146:Pain / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging