title: The (f)utility of flexion-extension C-spine films in the setting of trauma.
abstract: BACKGROUND
  Flexion-extension radiographs are often used to assess for removal of the cervical collar in the setting of trauma. The objective of this study was to evaluate their adequacy. We hypothesized that a significant proportion is inadequate.
  
  
  METHODS
  This was a retrospective review of C-spine clearance at a level 1 trauma center. A trauma-trained radiologist interpreted all flexion-extension radiographs for adequacy. Studies performed within 7 days of injury were considered acute.
  
  
  RESULTS
  Three hundred fifty-five flexion-extension radiographs were examined. Ninety-five percent% of these studies were inadequate (51% because of the inability to visualize the top of T1, whereas 44% had less than 30° of angulation from neutral). Two hundred ten studies were performed acutely; of these, 97% were inadequate. When performed 7 days or longer from injury, 91% were inadequate.
  
  
  CONCLUSIONS
  Injury to the C-spine may harbor significant consequences; therefore, its proper evaluation is critical. The majority of flexion-extension films are inadequate. As such, they should not be included in the algorithm for removal of the cervical collar. If used, adequacy must be verified and supplemental radiographic studies obtained as indicated.
authors.affiliation: Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
authors.forename: Vasiliy
authors.initials: V
authors.lastname: Sim
authors.forename: Mark P
authors.initials: MP
authors.lastname: Bernstein
authors.forename: Spiros G
authors.initials: SG
authors.lastname: Frangos
authors.forename: Chad T
authors.initials: CT
authors.lastname: Wilson
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Simon
authors.forename: Christopher M
authors.initials: CM
authors.lastname: McStay
authors.forename: Paul P
authors.initials: PP
authors.lastname: Huang
authors.forename: H Leon
authors.initials: HL
authors.lastname: Pachter
authors.forename: Samual Robert
authors.initials: SR
authors.lastname: Todd
mesh_terms: D000328:Adult; D000465:Algorithms; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014962:X-Ray Film / Q000706:statistics & numerical data*
keywords: Adequacy; Cervical spine injury; Flexion/extension radiography; Trauma