Probably you had this dilemma before. Patient involved MVC with midline neck tenderness and negative CT scan. Now, what should I do? Should I clear and remove c-collar or consult with trauma. There are 2 approaches that trauma surgeons usually do. 1:MRI and/or 2: Flex-ex xray.
There were not too many EBM studies in ED to support these approaches and it is usually based on expert opinion. annals of emergency medicine published an article Dec, 2011 regarding this topic. Please note that the study was done in in acute, alert, neurologically intact trauma patients with computed tomography (CT) imaging negative for acute injury and persistent midline cervical spine tenderness.
44% of patients had acute cervical spine injuries detected on MRI. Of these patients, 62% had a single-column injury (n=48), 19% had two-column injuries (n=15), and 6%
had three-column injuries (n=5). Of the remaining 10 patients, 6 had isolated posterior muscle edema, 2 had alar ligamentous edema, 1 had epidural hematoma, and 1 had atlanto occipital edema.