Clearing the Cervical Spine in Obtunded Patients: The Use of Dynamic Fluoroscopy


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Abstract

Objective Obtunded patients (Glasgow Coma Scale score of <13) with normal cervical roentgenograms remain in collars until they can be clinically evaluated. Cervical collars provide incomplete immobilization and have complications. Our hypothesis was that cervical spines could be evaluated in obtunded patients with normal cervical roentgenograms using dynamic fluoroscopy.Design This study was a prospective clinical evaluation.Methods Obtunded trauma patients with normal cervical roentgenograms underwent fluoroscopic examination of the cervical spine through a full range of motion.Results Fluoroscopic evaluations were done in 116 patients. There were 113 true negative examinations. Two patients had facet fractures not diagnosed on cervical roentgenograms, and no instability on fluoroscopy. One patient had a positive exam, with 2 mm of subluxation. There were no neurologic complications. Decubiti were present in 44% and were more frequent when the collar was on >5 days (p = 0.029).Conclusions Dynamic fluoroscopy can safely and effectively clear the cervical spine in obtunded patients. Earlier removal of the collar decreases decubiti.

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