![]() The objective of this study was to develop a consensus-based radiographic definition of cervical instability for routine use in patients who sustain trauma to the cervical spine. Therefore, a standardized TCSI definition is needed to improve agreement among chiropractic clinicians and radiologists. In fact, it is estimated that 4% to 23% of patients experience a delay in their diagnosis because of inadequate radiographic evaluation, misinterpretation, or misdiagnosis. Although screening guidelines for imaging are available, no consensus or standardized criteria exist to diagnose TCSI on radiographs. However, these tools do not provide criteria to evaluate cervical spine radiographs.Īlthough most radiographs reveal no signs of traumatic lesions, any delay in recognizing a cervical fracture/dislocation and segmental instability can lead to catastrophic damage including sensory impairment (monoparesia, hemiparesia), motor deficit (tetraplegia), microfractures, and dislocations (“subluxations”) >3 mm. The purpose of these tools is to inform whether radiographs or computed tomography (CT) scans should be ordered in the emergency room for patients with acute cervical spine trauma. Validated prediction tools, such as the Canadian C-Spine Rule and the National Emergency X-Radiography in the Emergency Room Utilization Study (NEXUS) low-risk criteria, are available to clinically screen patients who sustained blunt trauma. For example, little is known about the screening and diagnostic accuracy of the commonly used definition proposed by White and Panjabi : “Clinical instability the loss of the ability of the spine under physiologic loads to maintain its pattern of displacement so that there is no initial or additional neurological deficit, no other major deformity, and no incapacitating pain.” The absence of information on the reliability and validity of these definitions limit their clinical utility. Although several clinical and radiological definitions are available, there is a lack of consensus among experts about their validity. The evaluation of cervical spine radiographs can be challenging because no standardized definition of traumatic cervical spine instability ( TCSI) is available to clinicians. ![]() Adults with blunt trauma have an annual incidence of cervical spine injury of 2% to 6%, and 0.2% to 0.6% are purely ligamentous injuries. In the United States, an estimated 11,000 cervical spinal cord injury cases are diagnosed annually and approximately 800,000 cervical spine radiographs are ordered to screen for cervical spine injury. KEYWORDS: Joint Instability Radiography SpineĮach year, emergency departments in the United States and Canada manage more than 13 million trauma patients at risk of cervical spine injury. Participants agreed that the presence of 1 or more of these clinical signs and symptoms and/or 1 or more of the 5 radiographic criteria on routine static radiographic studies suggests cervical instability.ĬONCLUSION: The consensus-based radiographic definition of traumatic cervical spine instability includes 6 clinical signs and symptoms and 5 radiographic criteria that doctors of chiropractic should apply to their patients who sustain trauma to the cervical spine. After 3 rounds of survey, 85% of participants approved the final consensus-based list of criteria for traumatic cervical spine instability screening, including 6 clinical signs and symptoms and 5 radiographic criteria. RESULTS: Twenty-nine chiropractic radiologists participated in round 1. Participants were asked to vote and reach agreement on the final screening criteria list in round 3. Items rated for inclusion by at least 75% of the participants in round 2 were used to create the consensus-based list of screening criteria. Items rated as important for inclusion by at least 60% of participants in round 1 were submitted for a second round of voting in round 2. Panelists were asked to rate potential screening criteria for traumatic cervical spine instability when assessing cervical spine radiographs. METHOD: We conducted a modified Delphi study with a panel of chiropractic radiologists. Toulouse, The purpose of this study was to establish consensus on a radiographic definition for cervical instability for routine use in chiropractic patients who sustain trauma to the cervical spine. Sarah Dion, DC, Maja Stupar, DC, PhD, Pierre Côté, DC, PhD, Send all comments or additions to: Manipulative Physiol Ther. CRITERIA TO SCREEN FOR TRAUMATIC CERVICAL SPINE INSTABILITY: A CONSENSUS OF CHIROPRACTIC RADIOLOGISTSĬriteria to Screen for Traumatic Cervical Spine Instability:
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