{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:15:57Z","timestamp":1784891757109,"version":"3.55.0"},"reference-count":62,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,12,20]],"date-time":"2015-12-20T00:00:00Z","timestamp":1450569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2016,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Detecting the presence of injuries to the cervical spine is an important component of the initial assessment of patients sustaining blunt trauma. A small proportion of cervical spine injuries consists of ligamentous disruption. Accurate detection of ligamentous injury is essential as it may result in sequelae including radiculopathy, quadriplegia and death. Flexion\u2013extension (FE) radiography has traditionally been utilised for the detection of ligamentous injury in patients who have been cleared of bony injury. There are controversies surrounding the use of FE for alert patients with neck pain. There are studies that call into question the diagnostic accuracy of FE, the high proportion of inadequate FE images due to muscle spasm and the adverse effects of prolonged cervical collar immobilisation while awaiting FE. Other literature indicates that FE provides no additional diagnostic information following a multi\u2010detector helical computed tomography. This review evaluates the literature on the utility of FE for the detection of ligamentous injury and explores alternate strategies for clearing the cervical spine of ligamentous injury.<\/jats:p>","DOI":"10.1111\/1742-6723.12525","type":"journal-article","created":{"date-parts":[[2015,12,21]],"date-time":"2015-12-21T04:54:39Z","timestamp":1450673679000},"page":"216-223","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Utility of flexion\u2013extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine"],"prefix":"10.1111","volume":"28","author":[{"given":"Jason Jaeseong","family":"Oh","sequence":"first","affiliation":[{"name":"St George Clinical School, Faculty of Medicine University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Edward","family":"Asha","sequence":"additional","affiliation":[{"name":"St George Clinical School, Faculty of Medicine University of New South Wales  Sydney New South Wales Australia"},{"name":"Emergency Department St George Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,12,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200103000-00009"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199303000-00006"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199112000-00010"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199910000-00012"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3171\/spi.2002.96.3.0285"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000199927.78531.b5"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007133430203"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.15.1841"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197506000-00011"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-012-2598-z"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181cf7e55"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181ae583b"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000430319.32247.7f"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2014.12.142"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000147"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200011150-00008"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181dc54bf"},{"key":"e_1_2_8_19_1","article-title":"Cervical flexion and extension radiographs in acutely injured patients","volume":"111","author":"Wang JC","year":"1999","journal-title":"Clin. Orthop."},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000176245.46965.e8"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000256449.95667.13"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.114319"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000147740.69525.58"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-007-0372-4"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31816b88a4"},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1177\/000313481007601219","article-title":"Do flexion extension plain films facilitate treatment after trauma?","volume":"76","author":"Duane TM","year":"2010","journal-title":"Am. Surg."},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000169807.96533.F2"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200209000-00005"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2013.09.001"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2006.12.004"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-006-0084-1"},{"key":"e_1_2_8_32_1","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1093\/miled.167.5.398","article-title":"Clearing the cervical spine in victims of blunt trauma","volume":"167","author":"DiGiacomo JC","year":"2002","journal-title":"Mil. Med."},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-6757(99)90185-7"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)81205-3"},{"key":"e_1_2_8_35_1","first-page":"166","article-title":"Flexion\/extension cervical spine views in blunt cervical trauma","volume":"15","author":"Nasir S","year":"2012","journal-title":"Chin. J. Traumatol."},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199004000-00019"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00572919"},{"key":"e_1_2_8_38_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2310\/8000.2011.110397","article-title":"The daunting task of \u2018clearing\u2019 the cervical spine","volume":"14","author":"Grunau BE","year":"2012","journal-title":"CJEM, Can. J. Emerg. Med. Care"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.116810"},{"key":"e_1_2_8_40_1","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1177\/000313480807400918","article-title":"A comparison of flexion and extension radiographs with computed tomography of the cervical spine in blunt trauma","volume":"74","author":"Goodnight TJ","year":"2008","journal-title":"Am. Surg."},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.05.100"},{"key":"e_1_2_8_42_1","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1177\/0310057X9802600502","article-title":"Optimal assessment of cervical spine trauma in critically ill patients: a prospective evaluation","volume":"26","author":"Ajani AE","year":"1998","journal-title":"Anaesth. Intensive Care"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200106000-00011"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-200093100-00005"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199810000-00026"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000195716.73126.12"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200201000-00011"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-002-0545-5"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000044629.69247.0A"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2007.08.006"},{"key":"e_1_2_8_51_1","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1177\/000313481007600622","article-title":"Flexion\u2013extension cervical spine plain films compared with MRI in the diagnosis of ligamentous injury","volume":"76","author":"Duane TM","year":"2010","journal-title":"Am. Surg."},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31812e51ae"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2371040697"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.140.8.762"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2013.06.005"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2351"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2013.01.036"},{"key":"e_1_2_8_58_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1177\/000313481007600411","article-title":"Computed tomography versus magnetic resonance imaging for evaluation of the cervical spine: how many slices do you need?","volume":"76","author":"Brown CV","year":"2010","journal-title":"Am. Surg."},{"key":"e_1_2_8_59_1","unstructured":"Royal Children's Hospital Melbourne.Cervical Spine Assessment.2012. [Last updated Dec 2012; cited 15 Sep 2015.] Available from URL:http:\/\/www.rch.org.au\/clinicalguide\/guideline_index\/Cervical_Spine_Injury\/"},{"key":"e_1_2_8_60_1","unstructured":"The College of Emergency Medicine Clinical Effectiveness Committee London.Guideline on the Management of Alert Adult Patients with Potential Cervical Spine Injury in the Emergency Department.2010. [Last updated Nov 2010; cited 15 Sep 2015.] Available from URL:http:\/\/www.rcem.ac.uk\/code\/document.asp?ID=5718"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181c9ccc8"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2013.3094"},{"key":"e_1_2_8_63_1","unstructured":"St George\/Sutherland Hospitals and Health Services.Clearance of a suspected cervical spine injury.2013. [Cited 8 Dec 2015.] Available from URL:http:\/\/www.seslhd.health.nsw.gov.au\/Trauma\/policies\/CervicalSpineInjuryClearanceSuspectedSGSHHS_ED.pdf"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1742-6723.12525","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.12525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T08:41:12Z","timestamp":1696322472000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.12525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,20]]},"references-count":62,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,4]]}},"alternative-id":["10.1111\/1742-6723.12525"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.12525","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"value":"1742-6731","type":"print"},{"value":"1742-6723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12,20]]},"assertion":[{"value":"2015-06-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-10-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-12-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}