Anekstein Yoram, Jeroukhimov Igor, Bar-Ziv Yaron, Shalmon Ehud, Cohen Nir, Mirovsky Yigal, Masharawi Youssef
Spine Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
Injury. 2008 Mar;39(3):339-46. doi: 10.1016/j.injury.2007.09.018.
Bedside flexion and extension fluoroscopy was proposed for detecting occult ligamentous instability in comatose trauma patients. Nevertheless, a recent study showed that the C7-T1 motion segment is rarely visualised by this technique. We propose a new method for clearing the cervical spine in comatose patients.
We conducted a prospective clinical pilot study on 31 consecutive comatose trauma patients to evaluate a new dynamic imaging technique for cervical spine clearance in comatose trauma patients. All patients were examined by a fine-cut helical CT scan of the entire cervical spine (C-spine) and by four-stage flexion-extension examination using the surview function of the CT scanner. The mean range of motion between extension and full flexion, the lowest visualised vertebrae, complications, positive findings, and the time from arrival to clearance was recorded.
The mean range of motion of the subaxial cervical spine was 39 degrees . The C7-T1 segment was fully visualised at the CT surview in 15 patients. The C6-C7 segment was visualised in all patients. No complication directly related to the study protocol was observed. C-spine clearance was completed in less than 6h from arrival in 26 patients.
The CT surview allows better visualisation of the C6-C7 and cervicothoracic junctions during flexion and extension. A short series of CT cuts can be used when visualisation is inadequate. Further studies are needed to assess the risks and benefits of the suggested protocol.
床边屈伸透视检查被用于检测昏迷创伤患者隐匿性韧带不稳定。然而，最近一项研究表明，该技术很少能显示C7 - T1运动节段。我们提出一种用于昏迷患者颈椎检查的新方法。
我们对31例连续的昏迷创伤患者进行了一项前瞻性临床初步研究，以评估一种用于昏迷创伤患者颈椎检查的新动态成像技术。所有患者均接受了全颈椎的薄层螺旋CT扫描，并使用CT扫描仪的全景功能进行了四阶段屈伸检查。记录了伸展和完全屈曲之间的平均活动范围、最低可见椎体、并发症、阳性结果以及从入院到检查完成的时间。
下颈椎的平均活动范围为39度。15例患者在CT全景检查中C7 - T1节段完全可见。所有患者的C6 - C7节段均可见。未观察到与研究方案直接相关的并发症。26例患者在入院后不到6小时内完成了颈椎检查。
CT全景检查能在屈伸过程中更好地显示C6 - C7和颈胸交界处。当显示不充分时可使用短系列CT扫描。需要进一步研究来评估所建议方案的风险和益处。
