TRAUMA and MISSED SPINAL INSTABILITY

TRAUMA and MISSED SPINAL INSTABILITY

Complete evaluation of the trauma victim is a critical component to avoid missing a catastrophic injury. I many cases there are injuries to the ligaments which hold the bones of the spine together, this results in a spine that is unstable potentially compromising the spinal cord and at a minimum accelerating the degenerative process.

In a paper by Yeo et al (2015) the authors stated “Prompt and accurate diagnosis of cervical spine injury is important to prevent the catastrophic results that can be caused by undetected lesions. Delayed or missed diagnosis of cervical spine injury occurs with an incidence of 5 to 20% according to previous studies.” [pg 146]

They reported “There has been a reduction in the incidence of delayed or missed diagnosis in recent years with developments in radiological diagnostic examination tools including computed tomography (CT) scan and magnetic resonance (MR) imaging. Nevertheless, incomplete radiological studies and misinterpretation are still common causes of delayed or missed diagnosis” [pg 147] Clinicians must have specialty training in the diagnosis and management of the trauma patient.

Regarding standard imaging, the authors report “In addition, suspicion of an injury of the posterior cervical ligament complex using only static radiographies, including MR imaging, may be insufficient to permit an exact diagnosis and determine proper management.” [pg 147]

Regarding imaging of the trauma victim the authors reiterate “The patients with cervical spine injury presenting with neck pain require radiological examination, even if the neurological examination shows normal condition” [pg 149]

Finally, they state, “In a disco-ligamentous injury, 30% of patients with ligamentous disruption displayed a negative result on static radiographies and CT scan, and it was identified by subsequent MR imaging.” [pg 149] When assessing and diagnosis injuries resulting from a traumatic injury to the human spine, there are many injuries than can be missed without careful consideration by using the right objective tools. Specialized training is required for the clinician to understand the potential underlying injuries in the traumatically injuried population.

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Reference:

1) 1. Yeo, C. G., Jeon, I., & Kim, S. W. (2015). Delayed or Missed Diagnosis of Cervical Instability after Traumatic Injury: Usefulness of Dynamic Flexion and Extension Radiographs. Korean Journal of Spine, 12(3), 146-149.

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