ER Detection of Further Spinal Damage

New research demonstrates that patients with a cervical spinal injury (CSI) may have further spinal damage not seen on traditional x-ray images. More than one-third of patients, in fact, who were believed to have low-risk injuries in the emergency room (ER) had additional damage, including considerable fractures with the potential to create debilitating spinal problems if not identified and treated correctly.

This study, published in the September 7, 2005, online issue of the journal Annals of Emergency Medicine, contradicts earlier beliefs that patients with specific types of spinal damage were thought to be at very low risk of having further injuries. Because of that low risk, clinicians were advised to use plain radiographs and avoid having to use computed tomography (CT) in assessing these cases.

"These findings are significant because they suggest that CT imaging, which allows physicians to view the spine in much greater detail, is necessary in evaluating all patients who have radiographic evidence of cervical spine injuries,” stated Dr. William Mower, professor of emergency medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA; USA), and lead author of the study.

Dr. Mower further reported that about one-fourth of these secondary injuries happened in another area of the cervical spine, which suggests that at least some of these patients may have actually sustained two separate spinal injuries. The investigators reviewed patient cases from the U.S. National Emergency X-Radiography Utilization Study (NEXUS), which was performed at 21 centers around the United States.

The authors discovered that x-rays could not identify secondary injuries in 81 of the 224 patients detected with CSIs (36%). "We also think that this is likely an underestimation, and the true prevalence of missed injury is probably even greater,” Dr. Mower stressed.

The investigators think that individuals with any evidence of CSIs, including those with CSIs previously thought to be at low risk for secondary injuries, should undergo CT scanning of the entire cervical spine. CT should be done to both determine whether secondary injuries are present and to detect those noncontiguous injuries that, in reality, happen in a considerable number of cases.