title: Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients.
abstract: BACKGROUND
  Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information.
  
  
  METHODS
  We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion-extension study for evaluation of potential cervical spine injury. All flexion-extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30° of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion-extension studies on clinical decision making was also reviewed.
  
  
  RESULTS
  One thousand patients met inclusion criteria for the study. Review of the flexion-extension radiographs revealed that 80% of the films either did not adequately demonstrate the C7/T1 junction or had less than 30° range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion-extension views had minimal effects on clinical decision making.
  
  
  CONCLUSIONS
  Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients.
authors: Trauma and Emergency Surgery Program, University of California Davis Medical Center, 2315 Stockton Boulevard Ste 4212, Sacramento, CA 95817, USA. bonnie.mccracken@udmc.ucdavis.edu
authors: Bonnie
authors: B
authors: McCracken
authors: Eric
authors: E
authors: Klineberg
authors: Brian
authors: B
authors: Pickard
authors: David H
authors: DH
authors: Wisner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011187:Posture; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
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