Assessment of stability of the cervical spine in blunt trauma patients: review of the literature, with presentation and preliminary results of a modified traction test protocol.

OBJECTIVE: To review the reported efficacy of various imaging techniques in assessing stability of the neck in blunt trauma patients, and to present the protocol and preliminary results of a modified traction test protocol. DESIGN: This is a prospective cohort study. SETTING: A regional trauma unit in Southern Ontario. PATIENTS: People with blunt-trauma injuries who came to the author's consultant practice with "C-spine not cleared" status, from January 2001 through December 2003. INTERVENTIONS: A fluoroscopically controlled test of axial traction followed by flexion/extension stressing. OUTCOME MEASURES: Radiographic confirmation of the absence of pathological motion under load. RESULTS: In 51 cases studied to date, no instabilities have been found. Four cases of minor ligamentous hypermobility have been detected, with stability confirmed and no surgery required. There have been no failures to depict the neck completely, no missed instabilities and no complications of the procedure. CONCLUSIONS: Cervical stability can be reliably confirmed with this test without any requirement for advanced imaging technology.