• Ali Y Mejaddam, Haytham M A Kaafarani, Elie P Ramly, Laura L Avery, Dante D Yeh, David R King, Marc A de Moya, and George C Velmahos.
• Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA 02114, USA.
• Am. J. Surg. 2015 Nov 1;210(5):822-6.

BackgroundA negative computed tomographic (CT) scan may be used to rule out cervical spine (c-spine) injury after trauma. Loss of lordosis (LOL) is frequently found as the only CT abnormality. We investigated whether LOL should preclude c-spine clearance.MethodsAll adult trauma patients with isolated LOL at our Level I trauma center (February 1, 2011 to May 31, 2012) were prospectively evaluated. The primary outcome was clinically significant injury on magnetic resonance imaging (MRI), flexion-extension views, and/or repeat physical examination.ResultsOf 3,333 patients (40 ± 17 years, 60% men) with a c-spine CT, 1,007 (30%) had isolated LOL. Among 841 patients with a Glasgow Coma Scale score of 15, no abnormalities were found on MRI, flexion-extension views, and/or repeat examinations, and all collars were removed. Among 166 patients with Glasgow Coma Scale less than 15, 3 (.3%) had minor abnormal MRI findings but no clinically significant injury.ConclusionIsolated LOL on c-spine CT is not associated with a clinically significant injury and should not preclude c-spine clearance.Copyright © 2015 Elsevier Inc. All rights reserved.

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