Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10369-10373
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10369
Clinical algorithm for preventing missed diagnoses of occult cervical spine instability after acute trauma: A case report
Ce Zhu, Hui-Liang Yang, Gi Hye Im, Li-Min Liu, Chun-Guang Zhou, Yue-Ming Song
Ce Zhu, Hui-Liang Yang, Li-Min Liu, Chun-Guang Zhou, Yue-Ming Song, Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Gi Hye Im, Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
Author contributions: Zhu C and Yang HL conceived the study design, carried out the study, and drafted the manuscript; Im GH and Liu LM carried out the initial analyses and reviewed and revised the manuscript; Zhou CG and Song YM coordinated and supervised data collection and critically reviewed and revised the manuscript for important intellectual content; all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work; Im GH is a native English speaker and refined the language of the manuscript; Zhu C and Yang HL contributed equally to this work.
Supported by grants from China Postdoctoral Science Foundation General Program No. 2019M653417; Sichuan Science and Technology Program, No. 2020YJ0025, No. 2017SZ0046, and No. 2017SZDZX0021; Post-Doctor Research Project, Sichuan University, No. 2019SCU12043; and International Postdoctoral Exchange Fellowship Program, No. PC2019060.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Guang Zhou, MD, PhD, Assistant Professor, Department of Orthopedic Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Road, Chengdu 610041, Sichuan Province, China. zcg_spine@163.com
Received: July 9, 2021
Peer-review started: July 9, 2021
First decision: July 26, 2021
Revised: July 29, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 26, 2021
Processing time: 135 Days and 16.5 Hours
Core Tip

Core Tip: Currently, there is no consensus on the optimal strategy for diagnosing occult cervical spine instability. We present a case of occult cervical spine instability and provide a clinical algorithm for diagnosing occult instability of the cervical spine. In this clinical algorithm, we recommend bedside lateral X-ray under traction or lateral X-ray after anesthesia and muscle relaxation prior to surgery as an effective, safe, and efficient method for detecting highly suspected instability of the cervical spine. We believe that this clinical algorithm will aid physicians in preventing missed diagnoses of occult instability of the cervical spine.