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Houston, TX, United States

Radcliff K.E.,Baylor College of Medicine | Ben-Galim P.,Baylor College of Medicine | Dreiangel N.,Baylor College of Medicine | Martin S.B.,University of Houston | And 4 more authors.
Spine Journal | Year: 2010

Background context: High-speed computed tomography (CT) exams have replaced traditional radiographs for assessment of cervical spine injuries in many emergency departments. Recent evidence demonstrates that even subtle displacements can indicate significant upper cervical spine injuries. Many different anatomical measurements have been described in the upper cervical spine to date, most of them based on X-ray. The range of anatomical relationships that exist in an uninjured population must be known to reliably detect abnormal relations. The measurements with the lowest normal variation are likely to be most useful in detecting injuries. Purpose: The purpose of this study was to describe the normal quantitative anatomical relationships as well as the threshold measurements most likely to detect injury in the upper cervical spine. Study design/Setting: Retrospective anatomical case review. Patient sample: Seventy-six thin-sliced cervical CT scans randomly selected from a trauma population, all negative for injury in the cervical spine. Methods: Forty-two different anatomical measurements were made of the upper cervical spine. These included traditional historical measurements and other detailed dimensions to characterize occipitocervical (OC) and atlantoaxial (AA) joint relationships. Results: After review of all the anatomical measurements performed in the upper cervical spine, direct measurements of the joint space had the least variation. The mean OC joint space was 0.6 mm, with an upper 95% confidence interval (CI) of 1 mm at the most anterior or posterior aspects of the joints. This was true for both sagittal and coronal measurements. The mean AA joint space was 0.6 mm, with an upper 95% CI of 1.2 mm at the lateral aspect of the joint on the coronal image only. The midsagittal structures demonstrated significantly higher standard deviation and variability. Conclusions: These results revealed consistently narrow joint spaces and left-right symmetry in the upper cervical spine joints that do not vary according to demographics. There was distinctly greater consistency in the coronal plane, which enabled more precise diagnostic measurement and side-to-side comparison of measurements. This precision will enable more accurate identification of abnormal scans, which should prompt consideration for additional workup. Thus, better understanding of these relationships may enable earlier detection of subtle craniocervical dissociative injuries based on CT scan data. This is important, because the only evidence of a severe injury on CT can be subtle misalignment. © 2010 Elsevier Inc. All rights reserved.

Dreiangel N.,Baylor College of Medicine | Ben-Galim P.,Baylor College of Medicine | Lador R.,Baylor College of Medicine | Hipp J.A.,Baylor College of Medicine | Hipp J.A.,Spine Research Laboratory Laboratory
Spine Journal | Year: 2010

Background context: Occipitocervical injuries (OCIs) are generally not common in blunt trauma victims, but autopsy studies of blunt trauma fatalities consistently report a high prevalence of these injuries. New computed tomography (CT)-based quantitative criteria have recently been developed for use in assessing the occipitocervical spine. The efficacy of these new criteria for detecting OCI would be supported if the high prevalence of OCI in blunt trauma fatalities can also be detected using these objective CT-based criteria. Purpose: To test the hypothesis that the prevalence of OCI in blunt trauma fatalities, determined using objective CT-based measurements and reliable reference data, will be similar to the prevalence reported in prior autopsy studies. Study design/setting: Retrospective assessment of the CT examinations of blunt trauma fatalities at a Level 1 trauma center. Patient sample: Seventy-four consecutive patients who died within 21 days of blunt trauma and had a CT examination of the cervical spine. Outcome measures: Quantitative measurements from CT examinations of the occiput-C1 and C1-C2 levels. Methods: Measurements were made on a Picture Archiving and Communication System (PACS) from the CT images that were originally used for diagnosis and also using imaging software that allowed for precisely reoriented slices that correct for variations in the alignment of the upper cervical spine. The prevalence of abnormal measurements found by each method and the interobserver reliability of the measurements were assessed. Results: At least one abnormal measurement was found in 50% of cases based on measurements made on the PACS, and in 34% of cases using measurements from carefully reoriented images. At least three abnormal measurements were found in 22% and 14% of patients, respectively. Only one of the patients had been diagnosed as having an OCI before death. Interobserver reliability measurements of more than 80% were found for most measurements. Conclusions: Using precise CT-based measurements and reliable reference data for diagnosis of occipitocervical dissociative injuries, the prevalence of injuries in severely injured blunt trauma patients was close to the levels reported in prior autopsy studies (approximately 30%). This supports that with careful measurements, both soft- and hard-tissue OCI can be detected by CT. This study is limited by the fact that a gold standard was not available to confirm the injuries. © 2010 Elsevier Inc. All rights reserved.

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