Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients

J Trauma. 2002 Jan;52(1):54-9. doi: 10.1097/00005373-200201000-00011.


Background: Between 1994 and 1999, 837 flexion-extension cervical spine films (F/E) were ordered as part of a protocol to evaluate cervical stability in blunt trauma victims, particularly obtunded patients with otherwise normal films. After 5 years' experience with this protocol, a review of its efficiency and cost-effectiveness was performed.

Method: The radiology reports and charts were reviewed for positive or suggestive F/E series.

Results: Nearly a third of all series were inadequate to rule out instability. Only four patients were identified who had decreased admission Glasgow Coma Scale score, normal plain films and/or CT, and positive or suggestive findings on F/E. One was felt to be a false positive, and the others had minor or borderline findings; all were treated with continuation of the cervical collar. Although one patient was lost to follow-up, none of the other three required subsequent surgery or developed deformity or neurologic injury.

Conclusion: Flexion-extension studies were not a cost-effective part of the protocol, and they were dropped.

MeSH terms

  • Cervical Vertebrae / diagnostic imaging*
  • Cervical Vertebrae / injuries*
  • Cervical Vertebrae / physiopathology
  • Cost-Benefit Analysis
  • False Positive Reactions
  • Glasgow Coma Scale
  • Humans
  • Joint Instability / diagnostic imaging
  • Joint Instability / economics
  • Joint Instability / physiopathology
  • Manipulation, Spinal
  • Radiography / economics*
  • Range of Motion, Articular / physiology
  • Spinal Cord Injuries / diagnostic imaging*
  • Spinal Cord Injuries / economics
  • Spinal Cord Injuries / physiopathology
  • Tomography, X-Ray Computed / economics
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Wounds, Nonpenetrating / economics
  • Wounds, Nonpenetrating / physiopathology