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Invited Commentary
September 2016

Does the Computed Tomographic Scan Tell the Whole Story for Cervical Spine Clearance?

Author Affiliations
  • 1Division of Trauma, Burn and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Surg. 2016;151(9):813-814. doi:10.1001/jamasurg.2016.1271

Stabilization of the spine with rigid collars has been well established as a useful early intervention for preventing spinal cord injuries among trauma patients.1 Clinical examination and, in some cases, radiographic evidence showing the absence of clinically significant injuries are routinely required prior to making decisions regarding the removal of these collars, a process known as cervical spine clearance.2 Because thorough clinical examinations require intact sensorium and sobriety, there have been debates on the safety of cervical spine clearance among intoxicated patients.2 The study by Bush et al3 in this issue of JAMA Surgery is an impressive effort to prospectively evaluate the accuracy of using only computed tomographic (CT) scans as the basis for excluding potential spinal cord injuries among intoxicated trauma patients. Using a single institution’s data, this study showed that a normal CT finding alone could predict the absence of significant spinal injuries in more than 99% of cases.3 The results of this study suggest that it is unnecessary to delay cervical spine clearance until intoxicated patients are sober or until magnetic resonance imaging is performed. However, caution must be taken in making conclusions based on these data.

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