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C-spine clearance

Avi Roy Shapira trauma-list@trauma.org
Fri, 25 Apr 2003 13:55:36 +0300 (IDT)


I didn't wish to imply that. All i've meant to say is that cross table
lateral by itself does not rule out c-spine fracture. I agree with your

Many respondants asked if there were data to show that CT is inadequate.  

This is the wrong question. In order to accpet a new method such as CT,
one needs to show that CT is adequate. 

Some have quoted studies which show that it is. Well and good. It probably
is, and the next edition of the ATLS may have that in liew of
X-rays.  As some of the quoted studies are to be published soon (but not
yet) those of us who are not privy to the information cannot use it. 

Yoram, relying on our ministry of health, had claimed this is the standard
of care. I was merely pointing out that it was at least a premature


On Wed, 23 Apr 2003 DocRickFry@aol.com wrote:

> In a message dated 4/23/2003 7:52:18 PM Eastern Daylight Time, 
> shereej@gmp.usyd.edu.au writes:
> > statement 1: the ATLS no longer advocates Xtable lateral c spine 
> > filmstatement 2: You can clear the c-spine clinically, or with plain
> > films using 3 views
> > 
> > 
> 3 views of the c-spine does NOT clear the c-spine by itself, which you seem 
> to indicate.  If a patient is tender, or is unevaluable, the 3 views (or what 
> is becoming increasingly clear, CT) is only the first step--the collar cannot 
> be removed unless the patient is then documented to have no pain on passive 
> AND active exam, or, if persisitently unevaluable or tender, an MRI or uprite 
> flex-ex is normal.

Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390