Clearing the cervical spine in victims of blunt assault to the head and neck: what is necessary?

A number of guidelines have been proposed to aid in determining the need for radiologic evaluation of the cervical spine (c-spine) in victims of blunt trauma. Mechanism of injury has not been shown to be an independent predictor of injury or the lack thereof. The current study was undertaken to determine the incidence of clinically relevant c-spine injuries in patients who sustained a blunt assault to the head and neck. The trauma registry of an urban Level 1 trauma center was used to identify patients who suffered a blunt assault to the head and neck and were admitted to the hospital over a 30-month period. One hundred two patients were identified. Only 8 patients met criteria for clinical clearance of the c-spine. Eighty patients were unable to be evaluated because of head injury or intoxicants; 14 patients had neck pain on initial examination. These 94 patients underwent plain film examination of their c-spine. Twelve required CT scanning to supplement visualization. The possibility of ligamentous injury was investigated by MRI or flexion/extension radiographs in 26 patients. No clinically significant c-spine injuries were identified. Although many victims of a blunt assault to the head and neck region may have a decreased LOC or neck pain, the likelihood of a ligamentous injury is so low that plain-film X-ray evaluation of the c-spine is all that is necessary to rule out injury in this patient population.