title: The daunting task of "clearing" the cervical spine.
abstract: The evaluation of the cervical spine in the emergency department is a common and often challenging task. We report the case of a 70-year-old female who presented intoxicated with evidence of a recent fall. A 64-slice computed tomographic (CT) scan with sagittal and coronal reconstructions revealed no acute injury. The patient was re-examined when alert and had persistent neck pain. Flexion-extension static views revealed severe subluxation of C5 on C6 with jumped facets, and subsequent magnetic resonance imaging confirmed significant ligamentous injury. The evidence available suggests that although CT with reconstruction is highly sensitive for clinically significant cervical injury, the possibility of severe injury remains.
authors.affiliation: Emergency Department, St. Paul's Hospital, and Department of Emergency Medicine, University of British Columbia, Vancouver, BC. briangrunau@gmail.com
authors.forename: Brian E
authors.initials: BE
authors.lastname: Grunau
authors.forename: Daniel
authors.initials: D
authors.lastname: Dibski
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hall
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000435:Alcoholic Intoxication; D002574:Cervical Vertebrae; D003221:Confusion; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D019547:Neck Pain / Q000209:etiology*; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed