Blunt Trauma Patients with Cervical Stenosis and No Fracture are More Likely to Have Neurologic Deficits and Require Surgery than those without Stenosis

The protocols for safely removing the cervical collar or clearing the cervical spine in alert adult blunt trauma patients are well established, and recently the Eastern Association for the Surgery of Trauma (EAST) has published guidelines suggesting that the cervical spine in obtunded patients with blunt trauma can be cleared with a CT scan that is negative for fracture.1 The authors acknowledge that although these recommendations are based on a systematic review of very low quality of evidence, there was a 100 per cent negative predictive value to identify an unstable cervical injury.1 This review, however, did not discuss the effect cervical stenosis may have on these injuries. [...]it may be important to evaluate these patients with early MRI to determine whether spinal cord compression is present, which could possibly decrease the time until surgical intervention when indicated. A retrospective case series study design was used to compare clinical outcomes (spinal cord compression, neurologic deficits, and surgical treatment) in blunt trauma patients with and without cervical stenosis admitted to a Level II trauma center. [...]the study population is skewed by the fact that an MRI was typically ordered to evaluate for ligamentous injury or spinal cord compression because of a concerning neurologic examination.