The clinical significance of isolated loss of lordosis on cervical spine computed tomography in blunt trauma patients: a prospective evaluation of 1,007 patients

•We investigated whether isolated LOL on c-spine computed tomographic scan should preclude c-spine clearance in adult blunt trauma patients.•Clinically significant injury was detected by magnetic resonance imaging, flexion–extension views, and/or repeat physical examination.•Isolated LOL on c-spine CT is not associated with a clinically significant injury.•Isolated LOL on c-spine CT should not preclude c-spine clearance.

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.