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C-spine clearance

Karim Brohi trauma-list@trauma.org
Sat, 26 Apr 2003 23:09:04 +0100


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Errington,

Protocols that include whole cervical spine helical CT to evaluate the spine
must include both sagittal and coronal reconstructions.  This is the only
way to assess the indirect signs of ligamentous injury - distraction,
translation or rotation

Karim
  -----Original Message-----
  From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]On
Behalf Of ecthompson
  Sent: 26 April 2003 19:34
  To: trauma-list@trauma.org
  Subject: RE: C-spine clearance


  I would add that sagittal reconstructions are very helpful.  Plain films
of the c-spine are .retardedly difficult to interpret.  There are so many
shadows that overlap and criss-cross.  Line-up these lines on this view,
then look at the Scotty dog on this view, the odontoid has .. It is near
impossible to truly feel comfortable about c-spine plain films.



  E



  Errington C. Thompson, MD

  Trauma Surgeon

  Trinity Mother Frances

  Tyler, Tx

  ecthompson@tyler.net



  Don't think you are

  Know you are

                              - Morpheus (The Matrix)



  -----Original Message-----
  From: trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org]
On Behalf Of DocRickFry@aol.com
  Sent: Saturday, April 26, 2003 7:59 AM
  To: trauma-list@trauma.org
  Subject: Re: C-spine clearance



  In a message dated 4/26/2003 6:18:34 AM Eastern Daylight Time,
jrmk@mweb.co.za writes:




  What I do want to as ask is whether their statement that they refuse full
neck CT, due to the amount of radiation involved.  They refuse to budge from
the fact that they will only CT the areas which show abnormality on X-ray
review (AP and lateral only are taken) if unevaluable or in the case of a
conscious patient, the areas of tenderness +- AP lateral X-rays
abnormalities.



  Well, a few points:
  First, IF you are going to use plain films as a screen, it is now well
established that a lateral, or the two views you use, are worthless--do not
at all accomplish what you want, i.e. screening for injury, because they can
miss too many.  You must at least do the standard three views--AP, lateral
and odontoid.
  Second--it is now becoming increasingly clear that CT of the full c-spine
far and away finds many more injuries than does plain films, and several
papers are now coming out all showing this.  We used to have the same
philosophy as your radiologists, but this should be reconsidered.
  As a start if you want to acquaint yourself with the current literature
and consensus, try the EAST Practice Management Guidelines at www.east.org.
Also on that website is a listing of the abstracts from the 2003 EAST
meeting, where you will find 5 papers dealing with c-spine clearance that
will be published later this year--all conclude the same thing regarding CT
vs plain films
  ERF


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<DIV><SPAN class=3D428383219-26042003><FONT color=3D#0000ff=20
size=3D2>Errington,</FONT></SPAN></DIV>
<DIV><SPAN class=3D428383219-26042003><FONT color=3D#0000ff=20
size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D428383219-26042003><FONT color=3D#0000ff =
size=3D2>Protocols that=20
include whole cervical spine helical CT to evaluate the spine must =
include both=20
sagittal and coronal reconstructions.&nbsp; This is the only way to =
assess the=20
indirect signs of ligamentous injury - distraction, translation or=20
rotation</FONT></SPAN></DIV>
<DIV><SPAN class=3D428383219-26042003><FONT color=3D#0000ff=20
size=3D2></FONT></SPAN>&nbsp;</DIV>
<DIV><SPAN class=3D428383219-26042003><FONT color=3D#0000ff=20
size=3D2>Karim</FONT></SPAN></DIV>
<BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
  <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
  size=3D2>-----Original Message-----<BR><B>From:</B> =
trauma-list-admin@trauma.org=20
  [mailto:trauma-list-admin@trauma.org]<B>On Behalf Of=20
  </B>ecthompson<BR><B>Sent:</B> 26 April 2003 19:34<BR><B>To:</B>=20
  trauma-list@trauma.org<BR><B>Subject:</B> RE: C-spine=20
  clearance<BR><BR></FONT></DIV>
  <DIV class=3DSection1>
  <P class=3DMsoNormal><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3=20
  FAMILY=3D"SANSSERIF"><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-bidi-font-family: Arial">I =
would add=20
  that sagittal reconstructions are very helpful.<SPAN=20
  style=3D"mso-spacerun: yes">&nbsp; </SPAN>Plain films of the <SPAN=20
  class=3DSpellE>c</SPAN>-spine are &#8230;retardedly difficult to =
interpret.<SPAN=20
  style=3D"mso-spacerun: yes">&nbsp; </SPAN>There are so many shadows =
that overlap=20
  and criss-cross. <SPAN style=3D"mso-spacerun: =
yes">&nbsp;</SPAN>Line-up these=20
  lines on this view, then look at the Scotty dog on this view, the =
odontoid has=20
  &#8230;. It is near impossible to truly feel comfortable about <SPAN=20
  class=3DSpellE>c</SPAN>-spine plain films.<SPAN style=3D"mso-spacerun: =
yes">&nbsp;=20
  </SPAN><o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoNormal><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-bidi-font-family: =
Arial"><o:p>&nbsp;</o:p></SPAN></FONT></P>
  <P class=3DMsoNormal><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-bidi-font-family: =
Arial">E<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoNormal><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-bidi-font-family: =
Arial"><o:p>&nbsp;</o:p></SPAN></FONT></P>
  <DIV>
  <P class=3DMsoAutoSig><st1:PersonName><FONT face=3D"Times New Roman" =
color=3Dnavy=20
  size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: =
yes">Errington</SPAN></FONT></st1:PersonName><FONT=20
  color=3Dnavy><SPAN style=3D"COLOR: navy; mso-no-proof: yes"> C. =
Thompson,=20
  MD<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: yes">Trauma=20
  Surgeon<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: yes">Trinity =
Mother=20
  Frances<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: yes">Tyler,=20
  Tx<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><st1:PersonName><FONT face=3D"Times New Roman" =
color=3Dnavy=20
  size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: =
yes">ecthompson</SPAN></FONT></st1:PersonName><FONT=20
  color=3Dnavy><SPAN=20
  style=3D"COLOR: navy; mso-no-proof: =
yes">@tyler.net<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: =
yes"><o:p>&nbsp;</o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: yes">Don't think =
you=20
  are<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: yes">Know you=20
  are<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoAutoSig><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-no-proof: yes"><SPAN=20
  style=3D"mso-spacerun: =
yes">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;=20
  </SPAN>- Morpheus (The Matrix)<o:p></o:p></SPAN></FONT></P></DIV>
  <P class=3DMsoNormal><FONT face=3D"Times New Roman" color=3Dnavy =
size=3D3><SPAN=20
  style=3D"FONT-SIZE: 12pt; COLOR: navy; mso-bidi-font-family: =
Arial"><o:p>&nbsp;</o:p></SPAN></FONT></P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><FONT face=3DTahoma =
size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Tahoma">-----Original=20
  Message-----<BR><B><SPAN style=3D"FONT-WEIGHT: bold">From:</SPAN></B>=20
  trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] =
<B><SPAN=20
  style=3D"FONT-WEIGHT: bold">On Behalf Of=20
  </SPAN></B>DocRickFry@aol.com<BR><B><SPAN=20
  style=3D"FONT-WEIGHT: bold">Sent:</SPAN></B> Saturday, April 26, 2003 =
7:59=20
  AM<BR><B><SPAN style=3D"FONT-WEIGHT: bold">To:</SPAN></B>=20
  trauma-list@trauma.org<BR><B><SPAN=20
  style=3D"FONT-WEIGHT: bold">Subject:</SPAN></B> Re: C-spine=20
  clearance</SPAN></FONT></P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><FONT face=3D"Times =
New Roman"=20
  size=3D3><SPAN style=3D"FONT-SIZE: =
12pt"><o:p>&nbsp;</o:p></SPAN></FONT></P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><FONT face=3DArial =
size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Arial">In a message dated =
4/26/2003=20
  6:18:34 AM Eastern Daylight Time, jrmk@mweb.co.za writes:<BR><BR=20
  style=3D"mso-special-character: line-break"><![if =
!supportLineBreakNewLine]><BR=20
  style=3D"mso-special-character: =
line-break"><![endif]><o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoNormal=20
  style=3D"MARGIN-BOTTOM: 12pt; MARGIN-LEFT: 0.5in; MARGIN-RIGHT: 0in; =
mso-margin-top-alt: 0in"><FONT=20
  face=3DArial size=3D2><SPAN style=3D"FONT-SIZE: 10pt; FONT-FAMILY: =
Arial">What I do=20
  want to as ask is whether their statement that they refuse full neck =
CT, due=20
  to the amount of radiation involved.&nbsp; They refuse to budge from =
the fact=20
  that they will only CT the areas which show abnormality on X-ray =
review (AP=20
  and lateral only are taken) if unevaluable or in the case of a =
conscious=20
  patient, the areas of tenderness +- AP lateral X-rays=20
  abnormalities.<o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><FONT face=3DArial =
size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Arial"><BR><BR>Well, a few=20
  points:<BR>First, IF you are going to use plain films as a screen, it =
is now=20
  well established that a lateral, or the two views you use, are =
worthless--do=20
  not at all accomplish what you want, i.e. screening for injury, =
because they=20
  can miss too many.&nbsp; You must at least do the standard three =
views--AP,=20
  lateral and odontoid.<BR>Second--it is now becoming increasingly clear =
that CT=20
  of the full c-spine far and away finds many more injuries than does =
plain=20
  films, and several papers are now coming out all showing this.&nbsp; =
We used=20
  to have the same philosophy as your radiologists, but this should be=20
  reconsidered.<BR>As a start if you want to acquaint yourself with the =
current=20
  literature and consensus, try the EAST Practice Management Guidelines =
at <A=20
  href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2003-April/3D"www.east.org">www.east.org</A>.&nbsp; Also on that website is =
a listing=20
  of the abstracts from the 2003 EAST meeting, where you will find 5 =
papers=20
  dealing with c-spine clearance that will be published later this =
year--all=20
  conclude the same thing regarding CT vs plain=20
  =
films<BR>ERF</SPAN></FONT><o:p></o:p></P></DIV></BLOCKQUOTE></BODY></HTML=
>

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