Objective: The purpose of this study was to establish consensus on a radiographic definition for cervical instability for routine use in chiropractic patients who sustain trauma to the cervical spine.

Method: We conducted a modified Delphi study with a panel of chiropractic radiologists. Panelists were asked to rate potential screening criteria for traumatic cervical spine instability when assessing cervical spine radiographs. Items rated as important for inclusion by at least 60% of participants in round 1 were submitted for a second round of voting in round 2. Items rated for inclusion by at least 75% of the participants in round 2 were used to create the consensus-based list of screening criteria. Participants were asked to vote and reach agreement on the final screening criteria list in round 3.

Results: Twenty-nine chiropractic radiologists participated in round 1. After 3 rounds of survey, 85% of participants approved the final consensus-based list of criteria for traumatic cervical spine instability screening, including 6 clinical signs and symptoms and 5 radiographic criteria. Participants agreed that the presence of 1 or more of these clinical signs and symptoms and/or 1 or more of the 5 radiographic criteria on routine static radiographic studies suggests cervical instability.

Conclusion: The consensus-based radiographic definition of traumatic cervical spine instability includes 6 clinical signs and symptoms and 5 radiographic criteria that doctors of chiropractic should apply to their patients who sustain trauma to the cervical spine.

Author keywords: Spine; Joint Instability; Radiography

Author affiliations: SD: Institut Franco-Européen de Chiropraxie (IFEC), Toulouse, France; MS: Department of Research, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; PC: Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; PC: University of Ontario Institute of Technology-Canadian Memorial Chiropractic College Centre for Disability Prevention and Rehabilitation, Toronto, Ontario, Canada; JMG: Université du Québec à Trois-Riviéres, Trois-Rivières, Quebec, Canada; JAT: D'Youville College, Buffalo, New York.

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