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Chiropractic Research Review

Relying on ER X-Rays May Be Dangerous

Plain radiographs of the cervical spine are generally performed in emergency departments when neck pain follows trauma from a motor-vehicle accident. Cervical spine fractures and dislocations - potentially life-threatening injuries - are often missed or undetectable on x-rays.

Computerized tomography (CT) scans are better for detecting these injuries, but are too cost-prohibitive to be taken routinely following trauma.

This case study involved a 77-year-old man suffering from neck pain after a motor-vehicle accident. Immediately following the crash, x-rays were taken at an emergency hospital, at which time the attending physician concluded there was no evidence of acute injury. Six days later, the man presented to a chiropractor with extreme pain, weakness, and dizziness. Based upon the findings of a standard physical examination, new x-rays revealed fractures and bilateral facet dislocation at C5 and C6. CT scans and magnetic resonance imaging (MRI) confirmed the fractures, as well as spinal cord compression and posterior cord displacement. The patient underwent surgery without complications.

Emergency departments may miss cervical spine fracture-dislocations using standard radiographic examinations; chiropractors should perform a comprehensive evaluation of patients suffering from cervical trauma, including x-rays, regardless of previous clinical findings. Additionally, chiropractors should be extremely cautious if considering cervical manipulation on patients suffering from cervical spine injury, despite "normal" findings on radiography.

Note: This paper serves as a good reminder that there are no substitutes for excellent physical examination skills, clinical reasoning, and critical thinking when it comes to proper patient management.

King SW, Hosler BK, King MA, et al. Missed cervical spine fracture-dislocations: The importance of clinical and radiographic assessment. Journal of Manipulative and Physiological Therapeutics 2002:25(4), pp. 263-269. www.mosby.com/jmpt

Chiropractic Research Review

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