There is loss of the normal cervical lordosis Osteophytic lipping of the vertebral bodies anteriorly at C3/4 and C5/6. There is some loss of normal cervical lordosisģ3 year old female with tingling in her left hand and reduced range of cervical movement. There is loss of normal cervical lordosis.ģ0 year old female with upper thoracic spine pain worse on cervical movementĤ2 year old female with neckpain post RTA/MVA. There is evidence of degenerative disease at the C5/6 level with osteophytic lipping of the vertebral bodies and retrolisthesis of C5 on C6. She reported dizziness related to her head position. This 77 year old lady was referred for cervical spine radiography with flexion and extension views. When in doubt, seek more information before proceeding. I cannot overemphasize the risks of this procedure in any patient and, in particular, in a patient with a recent injury. The patient may appear to be flexing and extending their cervical spine, but what they are actually doing is flexing and extending using their hips and lumbar spine. The pain from this trauma prevents the patients from flexing and extending their cervical spine. Patients will be referred for cervical spine flexion and extension radiography because of trauma to the cervical spine. Genuine Cervical Flexion and Extension Movementsįlexion and extension cervical spine radiography can be self defeating in the acute setting. 1999 Aug (365):111-6.Ĭervical flexion and extension radiographs in acutely injured patients. Wang JC, Hatch JD, Sandhu HS, Delamarter RB.Ĭlin Orthop Relat Res. Patients with cervical injuries may not be able to fully flex and extend their necks this may lead to false reassurance to patients who actually have had an inadequate study to diagnose potential instability. 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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