Flexion and extension cervical radiographs should not be obtained routinely in the emergency department because 13 of these studies will be inadequate because of pain and muscle spasms experienced by patients. Of the 290 flexion and extension radiographs, 97 (33.5%) of them showed such little or inadequate flexion or extension movement that cervical stability could not be assessed. In addition, there are reports of serious neurologic injuries occurring with the use of these radiographs in acutely injured patients. However, patients with acute injuries and severe pain and muscle spasms may not be able to move their necks effectively, severely compromising the diagnostic yield of the radiographs. Wang et al reported the followingįlexion and extension lateral radiographs of the cervical spine may suggest signs of ligamentous and soft tissue injuries in a potentially unstable spine. It is good radiographic practice to review the old imaging yourself (don't rely on others) to ensure that you are not putting the patient at risk- don't rely on a verbal assurance that the cervical spine CT was normal.Īn additional problem with functional views of the cervical spine in the trauma setting is that the patient may be unable or unwilling to flex and extend his/her neck. Given the risks of injury to the patient associated with functional cervical spine views, the requested functional views should be in writing (preferable from a neurosurgeon). Under no circumstances should routine flexion and extension views be performed in an acute setting without the supervision/consent of a neuosurgeon (or other suitably qualified medical specialist). This page considers all aspects of function cervical spine radiography.įlexion and extension views of the cervical spine should not be performed on patients with unstable cervical spine fractures. Despite this variability in acceptance, flexion and extension lateral cervical spine radiography is still practiced in some centres in the acute and/or follow up settings. The advent of MRI imaging has further reduced the acceptability of radiographic dynamic imaging of the cervical spine. Flexion and extension functional radiography has not been universally accepted as a diagnostic tool.
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