New Ways To Identify Spinal Injuries
Patients who have cervical spinal injuries may harbor additional spinal damage not visible on regular x-rays as per the reports from a National survey. It was rather surprising to find additional damage in more than one third of patients who were initially thought to have low-risk injuries. These damage may include significant bone fractures with the potential to produce serious spinal problems if not detected and treated properly.
It was the wisdom of the medical community until this study was published in Annals of Emergency Medicine patients with certain forms of spinal injury would be at very low risk for additional injuries. Because of this low risk, physicians were urged
to use plain x-rays rather than CT scans in evaluating these patients.
A new national study indicates that patients with a cervical spinal injury may harbor additional spinal damage not visible on regular x-rays. In fact, more than a third of patients who were thought to have low-risk injuries actually have additional damage that may include significant fractures with the potential to produce serious spinal problems if not detectedand treated properly.
This study, to be published as an early online release in the Annals of Emergency Medicine, contests previous medical thinking in which patients with certain forms of spinal injury were considered at very low risk of having additional injuries. Because of that low risk, physicians were urged to use plain x-rays and avoid computed tomography (CT) in evaluating these cases.
"These findings are significant because they suggest that CT imaging, which allows physicians to view the spine in much greater detail, is necessary in evaluating all patients who have radiographic evidence of cervical
spine injuries," said lead study author Dr. William Mower, professor of emergency medicine at the David Geffen School of Medicine at UCLA. "We found that even among patients with low-risk injuries, more than one-third sustained secondary damage that was not diagnosed by plain radiography."
Mower added that approximately one-fourth of these secondary injuries occurred in another part of the cervical spine, which suggests that at least some of these patients may have actually sustained two separate spinal injuries.
Scientists reviewed patient cases from the National Emergency X-Radiography Utilization Study, which was conducted at 21 centers across the United States.
Study authors found that x-rays failed to detect secondary injuries in 81 of the 224 patients identified with cervical spine injuries or 36 percent.
"We also believe that this is likely an underestimate, and the true prevalence of missed injury is probably even greater," Mower said.
The scientists think that patients with any evidence of cervical spine injury, including those with cervical spine injuries previously considered to be at low risk for secondary injuries, should undergo CT imaging of the entire cervical spine. CT should be obtained both to determine whethe secondary injuries are present and to identify those non-contiguous injuries that, in fact, occur in a substantial number of cases.