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this and that - Cervical Paranoia

felixalbers felixalbers at terra.com.br
Mon Oct 10 15:36:53 BST 2005

Yes yes yes, always the evidence is needed. But thinking about cervical instability is far away from bloodletting.

What I was trying to say is that there is no evidence on this. Maybe an isolated case-report, about an awake patient, without neuro deficit, with cervical pain, who sneezes and suddenly becomes tetraplegic.

But the EAST guidelines don´t  have the evidence to state that ligamentous instability may result in spinal cord injury in awake patients either. This is from the guideline: "If the screening radiologic studies are normal but the patient complains of significant neck pain, plain lateral x-rays should be obtained with the patient actively flexing and extending their neck. Pure ligamentous disruption can result in significant cervical spine instability that will usually be detected with such stress studies."

Stated like that, no good evidence. Reviewing the references from the EAST, there is only one study that adresses the flexion-extension views directly, and it didn´t find any unstable spines.

So, to my point. We have to discuss this based on logic. 

A recent article I read about a CT scan protocol for cervical trauma, from the Santa Barbara Hospital (J Trauma), has that same approach. Awake, no neuro deficit, normal CT = exclude medullary compression risk, even if there is cervical pain.



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Data:Mon, 10 Oct 2005 05:53:10 EDT

Assunto:Re: this and that - Cervical Paranoia

> In a message dated 10/9/2005 11:49:13 P.M. Eastern Daylight Time, 
> felixalbers at terra.com.br writes:
> in the alert patient, without neuro deficit, a normal CT rules out
> medullary compression risk. This is based on logic, not on evidence (just
> like your statement). I guess this is the problem with those injuries. Try
> to imagine an injured cervical spine
> Ahhh--the old "logic--who needs evidence?" approach--sorry but that went out 
> with the Dark Ages--or, at least, most of us thought so. By this reasoning w
> e would still be practicing bloodletting--which by the way was perfectly 
> logical to all physicians 200 years ago! What you say above is not true and 
> cannot be supported
> --
> trauma-list : TRAUMA.ORG
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