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Cervical spine clearance after blunt trauma: current state of the art

No definite consensus exists for the clearance of the cervical spine (C-spine) after blunt trauma, despite many validated algorithms, recommendations and guidelines. We intend to answer the most relevant questions with which physicians are confronted when clearing C-spines after blunt trauma in emer...

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Autores principales: Moeri, Michaël, Rothenfluh, Dominique A., Laux, Christoph J., Dominguez, Dennis E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Editorial Society of Bone and Joint Surgery 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197104/
https://www.ncbi.nlm.nih.gov/pubmed/32373348
http://dx.doi.org/10.1302/2058-5241.5.190047
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author Moeri, Michaël
Rothenfluh, Dominique A.
Laux, Christoph J.
Dominguez, Dennis E.
author_facet Moeri, Michaël
Rothenfluh, Dominique A.
Laux, Christoph J.
Dominguez, Dennis E.
author_sort Moeri, Michaël
collection PubMed
description No definite consensus exists for the clearance of the cervical spine (C-spine) after blunt trauma, despite many validated algorithms, recommendations and guidelines. We intend to answer the most relevant questions with which physicians are confronted when clearing C-spines after blunt trauma in emergency departments (EDs). To exclude significant C-spine injuries we designed an algorithm to be compatible with clinical practice, to simplify patient management and avoid unrewarding evaluation. We conducted an exploratory PubMed search including articles published from January 2000 to October 2018. Keywords used were “cervical spine”, “injury”, “clearance”, “Canadian C-spine Rule”, “CCR” and “national emergency x-radiography utilization study”. Clinical and experimental studies were included in a detailed review. We based our literature review on 33 articles. While answering fundamental triage questions from daily clinical practice, the current literature is discussed in detail. We designed an algorithm for the C-spine clearance suitable for any trauma centre with a high-quality multiplanar reconstruction computerized tomography (CT) scan continuously available. The high sensitivity of the Canadian C-spine Rule (CCR) prevents missing C-spine injuries while limiting the amount of unnecessary radiologic examinations. Plain radiographs were fully abandoned for C-spine clearance. A negative CT scan is sufficient to clear the majority of C-spine injuries and allows for collar removal. In case of motor symptoms or radio-clinical discrepancy, the advice of a specialized spine surgeon must be requested. Magnetic resonance imaging must not be routinely used. Neck pain despite negative imaging is not a reason to delay removal of stiff cervical collars. Cite this article: EFORT Open Rev 2020;5:253-259. DOI: 10.1302/2058-5241.5.190047
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spelling pubmed-71971042020-05-05 Cervical spine clearance after blunt trauma: current state of the art Moeri, Michaël Rothenfluh, Dominique A. Laux, Christoph J. Dominguez, Dennis E. EFORT Open Rev Spine No definite consensus exists for the clearance of the cervical spine (C-spine) after blunt trauma, despite many validated algorithms, recommendations and guidelines. We intend to answer the most relevant questions with which physicians are confronted when clearing C-spines after blunt trauma in emergency departments (EDs). To exclude significant C-spine injuries we designed an algorithm to be compatible with clinical practice, to simplify patient management and avoid unrewarding evaluation. We conducted an exploratory PubMed search including articles published from January 2000 to October 2018. Keywords used were “cervical spine”, “injury”, “clearance”, “Canadian C-spine Rule”, “CCR” and “national emergency x-radiography utilization study”. Clinical and experimental studies were included in a detailed review. We based our literature review on 33 articles. While answering fundamental triage questions from daily clinical practice, the current literature is discussed in detail. We designed an algorithm for the C-spine clearance suitable for any trauma centre with a high-quality multiplanar reconstruction computerized tomography (CT) scan continuously available. The high sensitivity of the Canadian C-spine Rule (CCR) prevents missing C-spine injuries while limiting the amount of unnecessary radiologic examinations. Plain radiographs were fully abandoned for C-spine clearance. A negative CT scan is sufficient to clear the majority of C-spine injuries and allows for collar removal. In case of motor symptoms or radio-clinical discrepancy, the advice of a specialized spine surgeon must be requested. Magnetic resonance imaging must not be routinely used. Neck pain despite negative imaging is not a reason to delay removal of stiff cervical collars. Cite this article: EFORT Open Rev 2020;5:253-259. DOI: 10.1302/2058-5241.5.190047 British Editorial Society of Bone and Joint Surgery 2020-04-06 /pmc/articles/PMC7197104/ /pubmed/32373348 http://dx.doi.org/10.1302/2058-5241.5.190047 Text en © 2020 The author(s) https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Spine
Moeri, Michaël
Rothenfluh, Dominique A.
Laux, Christoph J.
Dominguez, Dennis E.
Cervical spine clearance after blunt trauma: current state of the art
title Cervical spine clearance after blunt trauma: current state of the art
title_full Cervical spine clearance after blunt trauma: current state of the art
title_fullStr Cervical spine clearance after blunt trauma: current state of the art
title_full_unstemmed Cervical spine clearance after blunt trauma: current state of the art
title_short Cervical spine clearance after blunt trauma: current state of the art
title_sort cervical spine clearance after blunt trauma: current state of the art
topic Spine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197104/
https://www.ncbi.nlm.nih.gov/pubmed/32373348
http://dx.doi.org/10.1302/2058-5241.5.190047
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