Evaluation of the cervical spine in the polytrauma patient

Study Design. Two-part study. Part One: the analysis of surveys distributed to members of the Orthopaedic Trauma Association (OTA) and 1000 surgeon me mbers of NASS. Part Two:a prospective clinical study evaluating a new algor ithm to evaluate the cerivcal spine in polytrauma patients. Objectives. To determine if there is a consensus of the optimal method for "clearing the cervical spine"; to assess the safety and efficacy of a newly proposed algorithm. Summary of Background Data. There is no uniformly accepted algorithm for "c learing the cervical spine" in the polytrauma patient or those patients wit h altered mental status secondary to the influence of alcohol, drugs or a c losed head injury. Methods. All members of the OTA and 1000 surgeon members of NASS were sent questionnaires to assess their methods of "clearing the cervical spine" in the polytrauma patient. Their answers were collated, analyzed and compared to standard ATLS protocol guidelines. A new protocol, which includes a surg eon, controlled stretch test and flouroscopically visualized flexion-extens ion views, was initiated and evaluated for safety and efficacy. Results. Survey: Fifty-five percent of the members of the OTA and 31% of th e NASS surgeons responded to the questionnaire. Among the responses from th e NASS members, the ratio of orthopaedic spine surgeons to neurosurgeons ac curately parallels the society's membership (77% ortho, 23% neuro). Sixty-n ine of the OTA and 54% of the NASS responders : replied that they followed ATLS guidelines. Analysis of their responses showed only 40% compliance. Ei ghty-one percent of the OTA respondents utilize the standard three view cer vical spine trauma services, only 31% of the NASS members adhere to this gu idelines. Nearly 90% of ail respondents identified the presence of neck pai n or retropharygeal soft tissue swelling as an indicator to expand their in itial radiographic evaluation. There was no consensus as to management of t he polytrauma patient with a closed head injury. Eighty-two percent of all respondents has seen or treated a purely ligamentous injury of the c-spine. Spective Study: Prospective clinical protocol. 35-monthperiod: enrolled 153 patients, 12,000 patients seen in trauma unit. Completed data 149/153. 8/153 unable to be cleared due to poor visualizatio n of cervical-thoracic junction. 3/153 positive findings identified during fluoro examination. All three instability patterns verified in surgery (tru e positives). No untoward events to date. Conclusions. A standardized protocol to safely and effectively clear the ce rvical spine has yet to be established. Preliminary results of a new protoc ol to safely evaluate the cervical spine in the polytrauma patient are prom ising.