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Spinal Cord Injury Resulting From Injury Missed on CT Scan: The Danger of Relying on CT Alone for Collar Removal

  • Symposium: Complications of Spine Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Strict criteria have been used before removing cervical collars in patients with injuries who have midline pain or are unable to be reliably examined. This sometimes leads to prolonged immobilization in cervical collars or use of MRI to rule out injury. Several studies suggest a collar may be removed in the absence of fractures, dislocation, or pathologic subluxation on a cervical CT scan. This may avoid the morbidity of prolonged cervical immobilization or cost of advanced imaging study but risks devastating consequences from missing injuries.

Case Description

We report a patient with a cervical spinal cord injury after removal of a collar after a CT scan was misinterpreted as normal. Retrospective review of the CT showed subtle signs of widening between the spinous processes of the injured level, a finding easily missed without the use of further imaging studies.

Literature Review

Several articles suggest cervical collars may be safely removed from awake and alert patients and in patients who cannot be reliably examined after a negative CT scan without the need for further imaging.

Purposes and Clinical Relevance

CT scans are excellent at detecting bony injuries but not ligamentous injuries. Removing cervical collars based on CT scans alone may be expeditious, but some injuries may be missed without further imaging. Our case demonstrates the catastrophic consequences of missing a cervical spine injury and emphasizes the need for maintaining the cervical collar in high-risk patients until proper imaging can be obtained.

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Author information

Authors and Affiliations

  1. Advanced Orthopedic Center, 1641 Tamaimi Trail, Suite 1, Port Charlotte, FL, 33948, USA

    Gregory Gebauer MD, MS

  2. Department of Orthopedics, Thomas Jefferson University, Philadelphia, PA, USA

    Meredith Osterman MD & Alexander Vaccaro MD, PhD

  3. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    James Harrop MD

Authors
  1. Gregory Gebauer MD, MS
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  2. Meredith Osterman MD
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  3. James Harrop MD
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  4. Alexander Vaccaro MD, PhD
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Corresponding author

Correspondence to Gregory Gebauer MD, MS.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Thomas Jefferson University, Philadelphia, PA, USA.

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Gebauer, G., Osterman, M., Harrop, J. et al. Spinal Cord Injury Resulting From Injury Missed on CT Scan: The Danger of Relying on CT Alone for Collar Removal. Clin Orthop Relat Res 470, 1652–1657 (2012). https://doi.org/10.1007/s11999-012-2286-7

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  • DOI: https://doi.org/10.1007/s11999-012-2286-7

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