Mitch Harris, MD, is Chief of the Orthopedic Trauma Service, at Brigham and Women’s Hospital, and Associate Professor of Orthopaedic Surgery at Harvard Medical School.
Here, Dr Harris shares a very useful algorithm for evaluating patients with trauma to the cervical spine.
Imagine getting called to the Emergency Department to evaluate a painful and swollen knee after a skiing accident. The plain x-rays are read as normal, with no evidence of acute fracture and demonstrate evidence of degenerative arthritis of the knee. If the patient is experiencing too much pain to allow for an adequate exam, a knee brace will be provided and the patient re-evaluated in the office in 7-10 days. If there is significant ligamentous injury, the brace will suffice for temporary stability and a follow-up MRI might be required to fully define the extent of the injury.
Now consider another presentation. This time the mechanism of injury is a fall from standing in an elderly woman and the area of concern is her cervical spine. The patient has a black eye, no history of loss of consciousness and complains of neck pain while in the collar. There are no other associated injuries. Plain x-rays of her cervical spine are read as normal, with no evidence of acute fracture and demonstrate evidence of degenerative arthritis of the neck. The questions now are: what should the next tests be, and can the patient be safely discharged in a collar for a follow-up appointment in 1-2 weeks?
Normal appearing Left and Right facets of the cervical spine from MD Computerized Tomography (MDCT) scan.