Background: The diagnosis of the unstable cervical spine, and its subsequent management can be difficult and a missed cervical spine injury can obviously have devastating consequences.
Methods: This study describes a 6-year experience with these injuries and presents an algorithm for their evaluation. The case records of 100 consecutive patients who underwent an operative procedure for an unstable cervical spine injury were reviewed.
Results: The population and injury characteristics were similar to that of previous studies. The process of evaluation of the spine was robust but failed to identify two unstable ligamentous injuries not detected on initial radiologic examination. Ten patients whose injuries were missed at other hospitals were identified by using this system.
Conclusion: A systematic, well-structured approach to the potentially injured cervical spine allows safe and effective diagnosis and management of these patients. Failure to adhere to basic principles will result in missed unstable cervical spine injuries.