The Use of Bedside Fluoroscopy to Evaluate the Cervical Spine in Obtunded Trauma Patients

BACKGROUNDRecognition of a cervical spine injury is important to prevent further injury and in planning for future care. The management of the patient with a possible cervical spine injury who remains unresponsive is controversial. METHODSA retrospective evaluation of obtunded trauma patients admitted to the surgical intensive care unit who underwent bedside fluoroscopic cervical spine evaluation. Fluoroscopic findings and all complications were noted. RESULTSTwenty obtunded patients with possible cervical spine injuries underwent bedside fluoroscopic cervical spine evaluation. All patients had at minimum a normal three-view cervical spine series before fluoroscopy. Thirteen patients (65%) had the fluoroscopic examination completed at the bedside and were cleared. The complete cervical spine could not be evaluated in six patients (30%). One patient (5%) was found to have a C4-5 subluxation in the bedside examination. None of the patients had progression of their neurologic symptoms after cervical spine flexion/extension, and none developed evidence of spinal cord injury after being cleared during their hospital course. Cervical collars remained in place for 5.7 +/- 1.41 days (range, 1- 26 days). Three patients (15%) were noted to have decubiti under the cervical collar. CONCLUSIONIn this small study, the use of bedside fluoroscopy to evaluate the cervical spine appears safe and easy to perform. One unrecognized injury was identified. The technique is usually successful and gives reassurance that a significant cervical spine injury is not present.