Cervical spine immobilization following blunt XXXX : a systematic review of recent literature and proposed treatment algorithm.

@entity1 @entity51 @entity16 @entity130
BACKGROUND: Management of the cervical spine following blunt @entity130 is commonplace. In 2013, the American Association of Neurological Surgeons (AANS) and the @entity16 ( @entity16 ) published practice guidelines drawn from evidence dating to 2011. Since then, further publications have emerged that are reviewed, and a simple management algorithm produced to assist practitioners in Australian @entity130 centres. These publications attempt to shed light on two controversial scenarios, those being the management of symptomatic @entity1 with negative computed tomography (CT) and management of the obtunded @entity1 . METHODS: The search strategy mirrored that of the AANS/ @entity16 guidelines. A search of the National Library of Medicine (PubMed) database for manuscripts published between January 2011 and October 2014 was conducted. One reviewer extracted data from studies assessing the performance of various imaging modalities in identifying traumatic cervical spine injuries. In clinical scenarios where little evidence has emerged since the AANS/ @entity16 guidelines, key manuscripts published prior to 2011 were identified from bibliographies. RESULTS: Awake, asymptomatic @entity1 may be 'cleared' without further imaging. Awake, symptomatic @entity1 without pathology on CT and without @entity51 can safely be 'cleared' without magnetic resonance imaging. There is no longer a role for flexion-extension films. In the obtunded @entity1 , findings remain conflicting. CONCLUSION: Several of these findings represent a departure from previous practices, including clearance of @entity1 with non-neurological symptoms on the basis of CT and the exclusion of flexion-extension film in detecting injury. Management of the obtunded @entity1 remains controversial.
