The role of flexion and extension computed tomography with reconstruction in clearing the cervical spine in trauma patients: a pilot study.
OBJECTIVE
As a result of spinal trauma, approximately 12,000 individuals become quadriplegic or paraplegic each year in the US. The cervical spine is the most frequently injured part of the spinal column, and approximately 60% of spinal cord injuries involve the cervical region. The cervical collar remains the best method of prehospital spinal stabilization. Following trauma, difficulty securing an airway, the shielding of life-threatening injuries, and pressure ulcers are just a few of the serious problems that may be encountered in patients placed in cervical collars. The authors' goal was to develop an efficient method of clearing the cervical spine, by incorporating flexion and extension CT scanning with reconstruction (FECTR) into a trauma protocol.


METHODS
This prospective study reviewed consecutive patients evaluated by the neurosurgery and trauma services who underwent FECTR. Imaging studies were reviewed using the Picture Activating and Communication System. The incidence of injury detection was recorded, and detection of otherwise-missed cervical spinal injuries using FECTR and CT scanning were also recorded. This technique was also applied, without causing any new neurological complications, for comatose patients if the original CT showed no suspicion of unstable injury. The study end point was determination of the presence of cervical spinal column injury that would pose a threat of instability or injury to the patient.


RESULTS
Seventy-seven consecutive patients who underwent FECTR were identified. Far superior visualization of the cervicothoracic junction was achieved compared with flexion-extension cervical spine radiographs. In this case series, the sensitivity and specificity, respectively, of both FECTR and CT were 80% and 98.6% for all radiographic abnormalities. More importantly, for clinically unstable injuries, FECTR had a sensitivity of 100%. The use of FECTR added approximately 10-12 minutes to the time required for CT scanning.


CONCLUSIONS
The authors' initial findings show FECTR to be a safe, effective, and efficient method of posttraumatic cervical spine clearance. In unconscious or obtunded patients, FECTR facilitates cervical spine clearance with a high degree of accuracy. A larger prospective study is needed to confirm these findings.
Department of Neurosurgery, Louisiana State University Health Sciences Center–Shreveport, Louisiana 71130-3932, USA.
Rishi
R
Wadhwa
Samer
S
Shamieh
Justin
J
Haydel
Gloria
G
Caldito
Mallory
M
Williams
Anil
A
Nanda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007593:Joint Instability; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013124:Spinal Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult