Assessing cervical spine stability in obtunded blunt trauma patients: review of medical literature

PURPOSE: To review the current medical literature on dynamic fluoroscopic and magnetic resonance (MR) imaging assessment of cervical spine stability in obtunded patients who sustained blunt trauma. MATERIALS AND METHODS: The English-language literature within the Swetswise and Medline databases was searched for articles describing dynamic fluoroscopic or MR imaging assessment of cervical spine stability in patients who sustained blunt trauma. Patients with fractures or radiographic signs of injury were excluded. The frequencies of purely ligamentous injuries, injuries requiring immobilization, and other clinically important nonligamentous abnormalities were determined. RESULTS: The frequency of isolated cervical ligamentous injuries diagnosed with dynamic fluoroscopy, as reported in the literature, was 0.9% (11 of 1166 patients), whereas the reported frequency of these injuries diagnosed with MR imaging was 22.7% (125 of 550 patients). All injuries diagnosed with dynamic fluoroscopy and 101 (80.8%) of those diagnosed with MR imaging required continued cervical immobilization. Six (60%) of 10 injuries diagnosed with dynamic fluoroscopy and seven (5.6%) of 125 injuries diagnosed with MR imaging required surgical or halo stabilization. Five (2.5%) of the 200 obtunded patients assessed with MR imaging and six (0.5%) of the 1166 obtunded patients evaluated with dynamic fluoroscopy required surgery. CONCLUSION: Review of the current medical literature provided no clear evidence of the superiority of either MR imaging or dynamic fluoroscopy in the diagnosis of unstable ligamentous injury, although other relative advantages of MR imaging indicate that it is preferred for assessing cervical spine stability in obtunded blunt trauma patients.