header advert
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:



Full Access



Background: The safest and most effective method of early spine clearance in unconscious patients is the subject of intense debate.

Hypothesis: Helical CT is a sufficiently sensitive investigation to render dynamic screening of the cervical spine redundant.

Protocol: Our protocol for cervical spinal clearance in the unconscious patient since April 1994 involves the use of plain radiographs, CT scan (helical CT since 1997) and dynamic screening (DS).

Method: Over a ten-year period, April 1994 to September 2004, 839 patients were admitted to intensive care under the orthopaedic surgeons. 35 patients were excluded because of incomplete records.


  • Demographics: The mechanism of injury was a road traffic accident in 80% and the mean ISS was 24.1. There were 95 patients (10.9%) with a cervical spine fracture, 96 (10.8%) with a fracture in either / both thoracic and lumbar regions.

  • Spine clearance: Mean intubation (7.1 days), time to spine clearance (mean 0.4 days). In 318 patients, clearance was performed with the patient conscious (284 prior to intubation, 34 after intubation of < 24hrs). 42 patients (4.6%) died before spine clearance. In 10 patients, the protocol was not followed.

  • Inclusions: 434 patients underwent CT. 10 of the 95 cervical fractures were deemed stable and underwent DS (n = 349).

  • Missed Cases: CT missed 2 cases of instability, one of these (an atlanto-occipital dislocation) was also missed by DS. Critical analysis revealed a Powers ratio calculation would have diagnosed this injury on CT. Sensitivity (CT 97.7% vs DS 98.8%), specificity (100% CT and DS). There were no complications from either procedure.

Conclusion: DS is a safe procedure but has no real advantage over helical CT. Power’s ratio calculation is essential to reduce the chance of a missing an upper cervical injury. The cervical spine can be reliably cleared using helical CT alone.

Correspondence should be addressed to: Sue Woodward, Secreteriat, Britspine, Vale Clinic, Hensol Park, Vale of Glamorgan, CF72 8JY Wales.