title: The clinical significance of isolated loss of lordosis on cervical spine computed tomography in blunt trauma patients: a prospective evaluation of 1,007 patients.
abstract: BACKGROUND
  A negative computed tomographic (CT) scan may be used to rule out cervical spine (c-spine) injury after trauma. Loss of lordosis (LOL) is frequently found as the only CT abnormality. We investigated whether LOL should preclude c-spine clearance.
  
  
  METHODS
  All adult trauma patients with isolated LOL at our Level I trauma center (February 1, 2011 to May 31, 2012) were prospectively evaluated. The primary outcome was clinically significant injury on magnetic resonance imaging (MRI), flexion-extension views, and/or repeat physical examination.
  
  
  RESULTS
  Of 3,333 patients (40 ± 17 years, 60% men) with a c-spine CT, 1,007 (30%) had isolated LOL. Among 841 patients with a Glasgow Coma Scale score of 15, no abnormalities were found on MRI, flexion-extension views, and/or repeat examinations, and all collars were removed. Among 166 patients with Glasgow Coma Scale less than 15, 3 (.3%) had minor abnormal MRI findings but no clinically significant injury.
  
  
  CONCLUSIONS
  Isolated LOL on c-spine CT is not associated with a clinically significant injury and should not preclude c-spine clearance.
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Ali Y
authors.initials: AY
authors.lastname: Mejaddam
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Elie P
authors.initials: EP
authors.lastname: Ramly
authors.affiliation: Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Avery
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Dante D
authors.initials: DD
authors.lastname: Yeh
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: King
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: de Moya
authors.affiliation: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA. Electronic address: gvelmahos@partners.org.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D061330:Multidetector Computed Tomography; D009989:Orthotic Devices / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013124:Spinal Injuries / Q000175:diagnosis*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000453:epidemiology
keywords: Cervical spine; Computed tomography; Loss of lordosis; Trauma