With regard to your practice of performing dynamic active flexion/extension and lateral flexion in addition to the lateral rotation assessment recommended by the Canadian C-spine study investigators, 4 the Canadian C-spine study defined injury as clinically important when any fracture, dislocation or ligamentous instability was evident on radiographic imaging. We thank Drs Rahimi-Movaghar and Eslami for their comments in response to our article. Sina Trauma and Surgery Research Center Tehran University of Medical Sciences, Iran Reply Dear Editor Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Iran We ask the patient not to open the collar during sleep, because during sleep, neck tone is lost: defensive and abnormal uncontrolled movement is more possible during sleep than when awake.Īssociate Professor of Neurosurgery and Research Deputy If there is no neurologic deficit, but pain persists without abnormality in all imaging, including flexion and extension dynamic X-ray, we prescribe the wearing of a cervical collar for at least 48 hours. Additionally, if the patient with neck pain after trauma has normal images in all five views, we ask them to perform dynamic lateral flexion and extension as much as possible by him/herself to see whether there is any abnormality. Any film series that does not include these three views and does not visualise all seven cervical vertebrae and the junction of C7-T1 is inadequate. Among 5-views, three views are preferred: a true lateral view, which must include all seven cervical vertebrae as well as the C7-T1 junction, an anteroposterior view and an open-mouth odontoid view. Radiologic assessment: If the patient has an indication for imaging, recommendation of 5-view image is our first order. If the patient has no pain on history, no pain in midline cervical palpation and normal neck movement in the three directions, then there is a very low risk for cervical injury and questionable need for imaging, even if the patient has a high risk mechanism of injury. ![]() Passive cervical movement by the physician is prohibited. ![]() 3 However, we also ask the patient to move their spine in three directions (not only 45 degree lateral rotation): dynamic active flexion extension (by the patient, not by the physician) right and left lateral rotation and right and left bending. 1 We read this article with interest and would like to suggest clinical and radiologic add-ons to the cervical assessment following trauma.Ĭlinical assessment: We perform history taking and palpation of the midline cervical area the same as Nexus 2 and the Canadian C-spine rules. Add-on assessments of cervical vertebrae after trauma Dear EditorĪckland and Cameron (AFP April 2012) raised important issues on clinical and radiological assessment of cervical vertebrae after trauma.
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