Purpose: There is a dilemma regarding appropriate imaging of the blunt trauma patient with possible cervical spine injury who cannot cooperate with a clinical examination during a period of more than a few days after injury. This study reviewed relevant medical literature concerning the evaluation of the obtunded blunt trauma patient for potential radiographically occult cervical spine injury focusing on the use and results of dynamic fluoroscopy (DF) and magnetic resonance imaging (MRI).
Methods and Materials: A search of the English-language literature yielded eight articles dealing with DF evaluation of the cervical spine in the obtunded blunt trauma patient population. Seven other articles assessed cervical spine MRI examination in blunt trauma patients. Patients with fractures or radiographic signs of injury were excluded. The number of pure soft tissue injuries was tabulated along with those requiring immobilization; injury prevalence was calculated. Patients with adult SCIWORA (spinal cord injury without radiographic abnormality) were reviewed and the prevalence of lesions contributing to spinal cord injury was determined.
Results: The prevalence of isolated cervical ligamentous injuries in the DF and MRI populations studied was 1.0% and 23%, respectively. One percent of the total DF population and 18.6% of the MRI population had an injury requiring continued cervical precautions. 0.6% of DF patients and 1.6% of MRI patients had injuries warranting surgical stabilization. MRI detected contributory disc herniation in 28% of SCIWORA patients and other significant abnormalities in 41.2%.
Conclusion: The sensitivity and safety of DF are unproven. Based on its safety and apparent higher sensitivity for soft tissue abnormalities, MRI should be utilized to evaluate the cervical spine of the persistently obtunded (unreliable) blunt trauma patient for ligament, disc, and other soft tissue injuries that can influence treatment. Until the medical literature contains greater scientific evidence verifying its safety and diagnostic accuracy, DF should be avoided.