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Topic: Clearing the cervical spine

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	SpineSource \| Spondylolisthesis
		There are 33 vertebrae in the human spine: 7 in the neck area (cervical), 12 in the chest area (thoracic), 5 in the lumbar (lower back), 5 fused vertebrae in the pelvic area (sacrum) and 4 fused vertebrae forming the tailbone (coccyx).
		The posterolateral fusion involves placing bone graft in the posterolateral portion of the spine (behind and to one side of the spine).The surgical approach to the spine is from the back through a midline incision that is approximately three inches to six inches long.
		In order to place this instrumentation into the spine, the spine is at first exposed by making a skin incision, and then gently clearing the muscles, ligaments and other soft tissues from the levels of the vertebrae to be fused.
	www.spinesource.com /Back-Pain-Disorders/spondylolisthesis.html (1071 words)

	Education - X-Ray Library (Site not responding. Last check: 2007-10-13)
		It is unfortunate that many have extrapolated "diagnostic imaging" of the cervical spine to be synonymous with "protection." Patients are immobilized, often, for prolonged periods, bound to rigid uncomfortable equipment enduring the risk of aspiration and decubitus ulcers for fear of inadvertent iatrogenic injury to the spinal cord.
		This incidence of an unstable cervical spine fracture in a patient who cannot communicate the presence or absence of neck pain and who has normal screening films which visualize the entire cervical spine is not known.
		The incidence of injury to the cervical spine in patients with craniocerebral injury.
	www.swsahs.nsw.gov.au /livtrauma/education/x-ray/cspline.asp (3246 words)

	Persistent Symptoms after Apparent Minor Head Trauma
		Radiographic diagnosis of cervical spine injuries in the pediatric patient is complicated by the presence of ossification centers and synchondroses and especially by the effects of ligamentous laxity and hypermobility.
		Cervical spine injury (CSI) in the pediatric patient is relatively rare but of great diagnostic importance to the emergency physician since CSI can result in catastrophic sequelae.
		Cervical spine injury should be considered in all children sustaining multiple trauma, falls from heights and in those involved in MVCs.
	www.ferne.org /Lectures/strangeaaem0903.htm (5173 words)

	Stabilization
		It includes controlling any bleeding, keeping the person warm with blankets, feet elevated (unless spinal injuries are suspected), calming the person through personal attention and concern for their well-being, and arranging for proper evacuation as circumstances permit.
		It is particularly important in trauma cases where spinal[?] injury is suspected to immobilize the cervical spine, or back.
		EMTs trained in wilderness first aid have a technique for verifying that the spine has not been hurt ("clearing the cervical spine") when the victim is several hours or more from the hospital and evacuation may not be indicated.
	www.ebroadcast.com.au /lookup/encyclopedia/st/Stabilization.html (207 words)

	Cervical Arthritis Symptoms
		In cervical spine arthritis, the vertebrae in the neck, known anatomically as the cervical vertebrae, begin to degenerate, accompanied by degeneration in the flexible disks of shock-absorbing cartilage that fit between them.
		Cervical arthritis tends to begin between the ages of 30 and 50 as part of the normal aging process; like all arthritic conditions, it may grow worse over time.
		Once the cervical vertebrae and their disks begin to degenerate, a minor injury to the spine (such as that caused by a fall or sudden twist) may provoke symptoms.
	arthritis-symptom.com /Cervical-Arthritis-symptoms (1106 words)

	Clearing the cervical spine - Wikipedia, the free encyclopedia
		Clearing the cervical spine after blunt multitrauma is an important part of emergency medical care, aiming to avoid preventable quadriplegia due to undiagnosed unstable cervical spine injuries.
		If any doubt exists the patient’s spine must be immobilised before transport to a hospital or other facility.
		If the patient has a head injury with altered sensorium, is intoxicated, or has been given potent analgesics, then the cervical spine must remain immobilised until the clinical examination becomes possible.
	en.wikipedia.org /wiki/Clearing_the_cervical_spine (322 words)

	Welcome to THE MIDDLE EAST JOURNAL OF EMERGENCY MEDICINE
		CLEARING THE CERVICAL SPINE IN THE ACUTELY INJURED
		Routine CT scanning of the entire cervical spine of the acutely injured has been practiced in some trauma centres.(38) This does not appear to have made a significant addition to the diagnostic sensitivity acquired by plain radiography and supplementary CT study.
		The consensus, however, is that MRI is indicated in patients with neurological manifestations due to cervical spine cord or nerve roots injuries.
	www.hmc.org.qa /mejem/sept2003/Edited/review1.htm (2447 words)

	Clearing the Pediatric Cervical Spine Following Injury - Medical News Journal Update - Medcompare
		Problematic issues include child compliance with examination, the complex anatomy of the pediatric cervical spine, lack of agreement on definitive imaging modalities, and the coordination of multiple medical specialties.
		In addition to systematic procedures within the emergency department, preventing missed and delayed diagnoses of cervical spine injury can be facilitated by applying a clear methodology for reviewing radiographs in conjunction with the child’s clinical examination.
		This algorithm considers the adequacy of the images, alignment of the bony and soft-tissue elements, assessment of the cervical intervals, and the presence of abnormal angulation.
	www.medcompare.com /litupdate.asp?ArticleID=11543 (203 words)

	Radiology of the Cervical Spine - Wheeless' Textbook of Orthopaedics
		Optimal assessment of cervical spine trauma in critically ill patients: a prospective evaluation.
		MRI evaluation of the cervical spine in the comatose or obtunded trauma patient.
		Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury: MRI for the evaluation of patients with occult cervical spine injury.
	www.wheelessonline.com /ortho/radiology_of_the_cervical_spine (890 words)

	EMedHome.com
		Cervical spine fractures are classified by mechanism through the Allen and Ferguson classification system (12).
		This injury is seen in up to 11% of cervical blunt trauma populations and presents as an expanding cervical hematoma, a bruit in patients under 50 years of age, an infarct seen on CT, significant facial hemorrhage from ears, nose or face, or symptoms consistent with a posterior circulation stroke (13, 14).
		Utility of Flexion and Extension Radiographs of the Cervical Spine in the Acute Evaluation in Blunt Trauma.
	www.emedhome.com /features_printfriendly.cfm?FID=1331 (6524 words)

	Clearing the cervical spine of paediatric trauma patients -- Slack and Clancy 21 (2): 189 -- Emergency Medicine Journal
		Clearing the cervical spine of adult victims of trauma.
		Utility of the cervical spine radiograph in pediatric trauma.
		Use of flexion-extension radiographs of the cervical spine in blunt trauma.
	emj.bmjjournals.com /cgi/content/full/21/2/189 (2344 words)

	Skin and Thyroid Dosimetry in Cervical Spine Screening: Two Methods for Evaluation and a Comparison Between a Helical ...
		Ionization chamber estimates.—For CT of the cervical spine, the
		The role of helical CT in the assessment of cervical spine injuries.
		Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening.
	www.ajronline.org /cgi/content/full/179/4/933 (3000 words)

	REFERENCES
		The radiology of acute cervical spine trauma, 3rd ed.
		Clearing the cervical spine in multiple trauma victims: a time-effective protocol using helical CT. Emergency Radiology 1994;1(6):273-278.
		Chronic neurologic sequelae of acute trauma to the spine and spinal cord.
	www.uth.tmc.edu /radiology/test/er_primer/ref.html (549 words)

	A Prospective Multicenter Study of Cervical Spine Injury in Children -- Viccellio et al. 108 (2): 20 -- Pediatrics
		The lower cervical spine is the most common site of CSI in children, and fractures are the most common type of injury.
		In: The Radiology of Acute Cervical Spine Trauma.
		Kriss VM, Kriss TC Imaging of the cervical spine in infants.
	pediatrics.aappublications.org /cgi/content/full/108/2/e20 (3648 words)

	BMJ This week in BMJ (Site not responding. Last check: 2007-10-13)
		Clearing the cervical spine in unconscious patients with trauma is done inconsistently
		A survey by Gupta and Clancy (p 1652) of intensive care units in the South and West region found no consistency in the minimum radiological investigations required or in whether the decision should be affected by the patient's unconscious state.
		They found an overreliance on the use of an isolated plain radiograph of the lateral cervical spine, although this view has a low sensitivity for detecting cervical spine injuries.
	bmj.bmjjournals.com /archive/7095t.htm (592 words)

	Emergency and Acute Care
		With the patient in a supine position, the spine is immobilized in a hard cervical collar, or sandbags, "logrolling," or a rigid spine board is used to completely immobilize the spine.
		A combination of a rigid cervical collar and supportive blocks on a backboard with straps is very effective in limiting motion of the cervical spine and is recommended (Hadley, et al 2002).
		Additional radiographs of the thoracic spine, the lumbar spine, and extremities for all patients with multiple injuries, or who are unconscious or neurologically compromised (Slucky and Eismont, 1995).
	calder.med.miami.edu /providers/MEDICINE/emerg1.html (1840 words)

	Critical Appraisal (Site not responding. Last check: 2007-10-13)
		This is adequate for assessing the necessity of the open-mouth odontoid view in the evaluation of the paediatric cervical spine.
		An alternative evaluation for clearing the paediatric cervical spine should be an initial AP and lateral x-rays followed by CT scan in cases of suspected c-spine injury.
		Prior to age of nine the paediatric cervical spine is anatomically distinct than the adult cervical spine and the odontoid view film is usually of poor quality.
	www.bestbets.org /cgi-bin/show.pl?AppraisalID=9 (1147 words)

	Cervical Spine Injury: A Clinical Decision Rule to Identify High-Risk Patients for Helical CT Screening -- Hanson et ...
		Cervical Spine Injury: A Clinical Decision Rule to Identify High-Risk Patients for Helical CT Screening -- Hanson et al.
		Thus, of the 84 patients in whom a cervical spine injury was
		Cervical spine imaging in patients with trauma: determination of fracture risk to optimize use.
	www.ajronline.org /cgi/content/full/174/3/713 (3073 words)

	Home
		By doing this there generally is a lift of the rib cage and a straightening of the upper spine or cervical vertebra.
		H., age 35, had severe curvature of the spine and was suffering with sciatic pain for months when he came for a session.
		At age 13 he was diagnosed as having scoliosis of the spine.
	www.alignment.org /Al.article.htm (2600 words)

	"ORANGE COUNTY CERVICAL SPINE ATTORNEYS,ORANGE COUNTY CAR CRASH LAWYERS,ORANGE COUNTY CERVICAL SPINE LAWYERS"
		Clearing the cervical spine is the process by which medical professionals determine that cervical spine injuries do not exist.
		If the patient has a head injury with altered sensorium, is intoxicated, or has been given potent analgesics, then the cervical spine must remain immobilised until the clinical examination becomes possible.
		If the patient is not expected to be clinically evaluable within 48-72 hours because of severe head or multiple injuries, he should remain immobilized until a time when such an examination is possible.
	damagelawyerorangecounty.net (368 words)

	2004CSJDobbs
		Clearing the cervical spine of unstable or significantly altered mental status trauma patients is a challenge.
		Negative radiographic evidence of fracture is not enough to remove cervical collars placed in the field or in the emergency department.
		A new protocol was developed to clear the cspine and a cost-effective alternative collar was implemented.
	www.aacn.org /AACN/NTIPoster.nsf/vwdoc/2004CSJDobbs?opendocument (171 words)

	Albrecht, et al., Cervical Spine Evaluation Of The Obtunded Blunt Trauma Patient Using MRI (Site not responding. Last check: 2007-10-13)
		INTRODUCTION: Clearing the cervical spine (CS) from injury in trauma patients who are obtunded from a closed head injury (CHI) is challenging.
		The purpose of this study was to review a Level I trauma center's experience with the use of early (<72 hours from injury) limited MRI to "clear" the CS extradural soft tissue injuries in patients with CHI.
		Osseous structures of the CS were cleared using radiographs and/or CT to view the occiput to Tl.
	www.aast.org /00abstracts/00absPoster_031.html (369 words)

	Letters to the Editor - cervical spine radiographs; social phobia; tar compounds for care of atopic dermatitis American ...
		Flexion-extension views should not be a part of the cervical spine evaluation in trauma patients.
		Of note, the routine cervical spine films may be inadequate in patients with blunt trauma, with upwards of 25 percent of lateral views being inadequate for visualization at the C7-T1 level.(4)
		To determine what approach the residency-trained, board-certified, emergency medicine colleagues at my institution routinely order for spinal trauma patients, the questions that accompanied the cervical spine article(1) were distributed for completion and comments.
	www.findarticles.com /p/articles/mi_m3225/is_11_61/ai_62829251 (792 words)

	Anaesthesia UK : FRCA Journal : Clearing the cervical spine after polytrauma: implementing unified management for ...
		Clearing the cervical spine after polytrauma: implementing unified management for unconscious victims in the intensive care unit - 3/8/2004
		Even though there have been several published guidelines on this subject, determining the best method for excluding cervical spine injury while a polytrauma victim is unconscious remains controversial.
		These authors have performed a survey, taking the form of a structured questionnaire, which demonstrated major differences between intensivists, neurosurgeons, orthopaedic surgeons and spinal surgeons with regard to the imaging modalities requested, the perception of their performance, the relative risks of missed injuries and the complications of immobilisation.
	www.frca.co.uk /JournalView.aspx?jid=64 (199 words)

	TRAUMA.ORG: (Site not responding. Last check: 2007-10-13)
		Collars intended for temporary use tend to be left on longer than anticipated and unfortunately, produce complications.
		First of all, if the patient has neck pain, his muscle contraction will prevent movement of the spine to a degree that it will be a non conclusive investigation.
		I have however had a few patients with cervical spine injury that have come the hospital a week or so after trauma because of continous pain.
	www.trauma.org /archives/csunco.html (1099 words)

	Educational DVD's
		This interactive DVD follows a clear pattern initially looking at the anatomy of the area, followed by detailed sections on observations, the most commonly used examination techniques, screening other structures, treatment progressions and exercise therapy.
		The emphasis of this DVD is on developing the viewer’s manual skills and to provide a reference of all the commonly used examination and treatment techniques.
		The Cervical and Thoracic Spine double DVD is a detailed, fundamental guide to examination and treatment of the neuromusculoskeletal system and the structures involved in this anatomical area.
	www.physioneeds.ie /education.htm (1399 words)

	Clearing the C-Spine (Site not responding. Last check: 2007-10-13)
		If the healthy patient has no history of neck problems and no symptoms on maximal flexion and extension, they are unlikely to have cervical spine disease.
		On the other hand there are many patients whose cervical spine SHOULD be radiographically evaluated pre-operatively including certain trauma patients, as well as those with disease states that affect the cervical spine including rheumatoid arthritis and Down's Syndrome.
		These diseases may affect the transverse ligament and thus the stability at the atlanto-axial joint.
	www.anest.ufl.edu /at/case3/c-spine.html (89 words)

	Clinical Clearance of Cervical Spinal Injuries by Emergency Nurses -- Hsieh et al. 7 (4): 342 -- Academic Emergency ...
		Clinical Clearance of Cervical Spinal Injuries by Emergency Nurses -- Hsieh et al.
		for clinically clearing the cervical spine in blunt trauma patients.
		clinically clearing the cervical spine for each patient.
	www.aemj.org /cgi/content/abstract/7/4/342 (295 words)

	NEJM -- Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma
		Myers, K. A clinical-decision rule for cervical spine injury.
		Bates, D., Butler, J. Cervical spine radiography in alert asymptomatic blunt trauma patients.
		Bloch, R. Absence of 5 clinical criteria ruled out cervical spine injury in blunt trauma in the emergency department.
	content.nejm.org /cgi/content/abstract/343/2/94 (1275 words)

	Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard ...
		Emergency transport and positioning of young children who have an injury of the cervical spine.
		the cervical spine was found to have anterior angulation or translation, or
		position for reduction of the injury of the cervical spine.
	www.ejbjs.org /cgi/content/abstract/71/1/15 (568 words)

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