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Lateral cervical film
0%
0/12
Three view cervical spine series
25%
3/12
Cervical immobilization
75%
9/12
IV methylprednisolone
Observation overnight
Select Answer to see Preferred Response
The patient is at risk for a cervical spine fracture due to whiplash injury. The neck should be immobilized by a cervical collar until cervical spine fracture can be ruled out by either a cervical spine series or CT. Cervical spine fractures should be suspected in patients following trauma to the head and neck and who present with symptoms of neck pain, motor weakness or sensory loss, mental status changes, loss of consciousness, and neck tenderness on palpation. Cervical radiographs should be used to evaluate for fractures (common types include Jefferson fracture, Hangman’s fracture, and odontoid fracture). Cervical immobilization is crucial to prevent spinal cord injury in the event of an undiagnosed fracture. Graber and Kathol review the role of cervical spine radiographs in the trauma patient and various types of common findings, including those discussed above. They suggest that in patients who have been deemed low-risk for significant injury, cervical spine radiographs are not required. They also discuss a syndrome in children called SCIWORA (spinal cord injury without radiographic abnormality) in which clinical judgement should take precedence over imaging. Anderson et al. performed a meta-analysis regarding appropriate clearance of the asymptomatic cervical spine in the asymptomatic patient group. They concluded that an alert, asymptomatic patient without a distracting injury or neurologic deficit who can perform a functional range-of-motion examination can be safely cleared without radiographic evidence. Illustration A displays the cervical spine clearance algorithm. Incorrect answers: 1. Lateral cervical film would not be sufficient for radiographic clearance. 2. Three view cervical spine series is often indicated if there is clinical evidence of fracture, but this is not the most appropriate first step. 4. IV methylprednisolone is controversial, as there has not been sufficient evidence to support its use, and treatment with steroids is associated with other adverse effects. 5. This is not sufficient to evaluate for cervical spine fracture.
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