Occult ligamentous injury of the cervical spine

Evaluating the cervical spine for injury is an essential part of the assess ment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliabl e clinical examination is not possible because of head injury, altered ment al status, or "distracting" injuries; In such cases, cervical spine injury that is not apparent on radiographs may be missed. This case report illustr ates a purely ligamentous cervical spine injury resulting in cervical insta bility, We describe our method of screening for and evaluating these types of injuries using physician-controlled stretch, flexion, and extension exam ination under fluoroscopy.