P49. Cervical spine CT scans can miss fractures when football equipment is in place

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

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Screening cervical spine MRI after normal cervical spine CT scans in patients in whom cervical spine injury cannot be excluded by physical examination

The American Journal of Surgery ◽

10.1016/j.amjsurg.2008.07.040 ◽

2008 ◽

Vol 196 (6) ◽

pp. 857-863 ◽

Cited By ~ 21

Author(s):

Megan Steigelman ◽

Peter Lopez ◽

Daniel Dent ◽

John Myers ◽

Michael Corneille ◽

...

Keyword(s):

Cervical Spine ◽

Physical Examination ◽

Cervical Spine Injury ◽

Ct Scans ◽

Spine Injury ◽

Spine Ct ◽

Spine Mri

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Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital

Diagnostic and Interventional Radiology ◽

10.5152/dir.2015.15003 ◽

2015 ◽

Vol 21 (5) ◽

pp. 423-427 ◽

Cited By ~ 11

Author(s):

Omid Khalilzadeh ◽

Maryam Rahimian ◽

Vinay Batchu ◽

Harshna V. Vadvala ◽

Robert A. Novelline ◽

...

Keyword(s):

Cervical Spine ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Second Opinion ◽

Ct Scans ◽

Trauma Patients ◽

Care Hospital ◽

Spine Ct

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A 2D threshold of the condylar–C1 interval to maximize identification of patients at high risk for atlantooccipital dislocation using computed tomography

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.10.peds16459 ◽

2017 ◽

Vol 19 (4) ◽

pp. 458-463 ◽

Cited By ~ 5

Author(s):

Vijay M. Ravindra ◽

Jay Riva-Cambrin ◽

Kevin P. Horn ◽

Jason Ginos ◽

Russell Brockmeyer ◽

...

Keyword(s):

Cervical Spine ◽

High Risk ◽

Predictive Value ◽

Screening Method ◽

Large Cohort ◽

Ct Scans ◽

Trauma Patients ◽

Occipitocervical Fusion ◽

Spine Ct ◽

Atlantooccipital Dislocation

OBJECTIVE Measurement of the occipital condyle–C1 interval (CCI) is important in the evaluation of atlantooccipital dislocation (AOD) in pediatric trauma patients. The authors studied a large cohort of children with and without AOD to identify a 2D measurement threshold that maximizes the diagnostic yield of the CCI on cervical spine CT scans obtained in trauma patients. METHODS This retrospective, single-center study included all children who underwent CT of the cervical spine at Primary Children's Hospital from January 1, 2011, through December 31, 2014, for trauma evaluation. Bilateral CCI measurements in the coronal (3 measurements per side) and sagittal (4 measurements per side) planes were recorded. Using an iterative method, the authors determined optimal cutoffs for the maximal CCI in each plane in relation to AOD. The primary outcome was AOD requiring occipitocervical fusion. RESULTS A total of 597 pediatric patients underwent cervical spine CT for trauma evaluation: 578 patients without AOD and 19 patients with AOD requiring occipitocervical fusion. The authors found a statistically significant correlation between CCI and age (p < 0.001), with younger patients having higher CCIs. Using a 2D threshold requiring a sagittal CCI ≥ 2.5 mm and a coronal CCI ≥ 3.5 mm predicted AOD with a sensitivity of 95%, a specificity of 73%, positive predictive value of 10.3%, and negative predictive value of 99%. The accuracy of this 2D threshold was 84%. CONCLUSIONS In the present study population, age-dependent differences in the CCI were found on CT scans of the cervical spine in a large cohort of patients with and without AOD. A 2D CCI threshold as a screening method maximizes identification of patients at high risk for AOD while minimizing unnecessary imaging studies in children being evaluated for trauma.

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Acute Traumatic Cervical Facet Fractures

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.83 ◽

2018 ◽

Vol 1 (2) ◽

pp. 5

Author(s):

Shankar Gopinat

Keyword(s):

Spinal Cord ◽

Cervical Spine ◽

Early Surgery ◽

Initial Assessment ◽

Trauma Patients ◽

Spinal Stability ◽

Fracture Patterns ◽

Spine Ct ◽

Cervical Facet

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.

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Quantitative measurement of syndesmophyte volume and height in ankylosing spondylitis using CT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-202661 ◽

2013 ◽

Vol 73 (3) ◽

pp. 544-550 ◽

Cited By ~ 24

Author(s):

Sovira Tan ◽

Jianhua Yao ◽

John A Flynn ◽

Lawrence Yao ◽

Michael M Ward

Keyword(s):

Ankylosing Spondylitis ◽

Dimensional Space ◽

Three Dimensional ◽

Reliability And Validity ◽

Intervertebral Disk ◽

Ct Scans ◽

Developmental Study ◽

Coefficients Of Variation ◽

Spine Ct ◽

Computer Based

ObjectiveSyndesmophyte growth in ankylosing spondylitis can be difficult to measure using radiographs because of poor visualisation and semiquantitative scoring methods. We developed and tested the reliability and validity of a new computer-based method that fully quantifies syndesmophyte volumes and heights on CT scans.MethodsIn this developmental study, we performed lumbar spine CT scans on 38 patients and used our algorithm to compute syndesmophyte volume and height in four intervertebral disk spaces. To assess reliability, we compared results between two scans performed on the same day in nine patients. To assess validity, we compared computed measures to visual ratings of syndesmophyte volume and height on both CT scans and radiographs by two physician readers.ResultsCoefficients of variation for syndesmophyte volume and height, based on repeat scans, were 2.05% and 2.40%, respectively. Based on Bland–Altman analysis, an increase in syndesmophyte volume of more than 4% or in height of more than 0.20 mm represented a change greater than measurement error. Computed volumes and heights were strongly associated with physician ratings of syndesmophyte volume and height on visual examination of both the CT scans (p<0.0001) and plain radiographs (p<0.002). Syndesmophyte volumes correlated with the Schober test (r=−0.48) and lateral thoracolumbar flexion (r=−0.60).ConclusionsThis new CT-based method that fully quantifies syndesmophytes in three-dimensional space had excellent reliability and face and construct validity. Given its high precision, this method shows promise for longitudinal clinical studies of syndesmophyte development and growth.

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What a Pain in the Neck!

Pediatric Traumatic Emergencies ◽

10.1093/med/9780190946623.003.0002 ◽

2020 ◽

pp. 13-22

Author(s):

Walter Wiswell ◽

Bryan McCarty

Keyword(s):

Decision Making ◽

Emergency Department ◽

Cervical Spine ◽

Neck Pain ◽

Pediatric Patient ◽

Ct Scans ◽

X Rays ◽

Pros And Cons ◽

Current Guidelines ◽

Patient Presentation

The chapter on cervical spine controversies in children describes what initial steps need to be taken in assessing a pediatric patient with neck pain after trauma, and discusses the decision-making process that goes into further evaluation and testing. Clinical actions and assessments of the patient on-scene, whether to pursue imaging once in the emergency department setting, and what imaging is most appropriate depending on the patient presentation are discussed. Indications and contraindications for cervical spine immobilization and spinal positioning, including proper techniques based on a patient’s age and whether or not such steps are necessary. It also discusses the pros and cons of x-rays, CT scans, and MRIs in the context of pediatric neck trauma, and current guidelines that should be followed when deciding to order such studies.

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CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31827e2acc ◽

2013 ◽

Vol 74 (4) ◽

pp. 1098-1101 ◽

Cited By ~ 16

Author(s):

Therèse M. Duane ◽

Andrew Young ◽

Julie Mayglothling ◽

Sean P. Wilson ◽

William F. Weber ◽

...

Keyword(s):

Cervical Spine ◽

Blunt Trauma ◽

Selective Approach ◽

Spine Ct

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Comparison of Dorsal-to-Ventral Ratios of the Cervical Paraspinal Musculature in French Bulldogs With and Without Cervical Intervertebral Disk Disease and Two Other Breeds Based on CT Scan Measurements

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.705632 ◽

2021 ◽

Vol 8 ◽

Author(s):

Julia Hart ◽

Stefan Rupp ◽

Katinka Hartmann ◽

Carolin Fischer ◽

Pia Düver ◽

...

Keyword(s):

Cervical Spine ◽

Ct Scan ◽

Body Length ◽

Vertebral Body ◽

Influencing Factor ◽

Intervertebral Disk ◽

Ct Scans ◽

Height Ratio ◽

Significant Difference ◽

Major Factors

Objective: To objectively assess the cervical paraspinal musculature of French bulldogs (FBs) using computed tomography (CT) scan-based measurements, outline differences in other breeds published in the literature, and investigate the potential influence of its cervical paraspinal musculature on predisposed sites for intervertebral disk disease.Animals: Thirty FBs that underwent CT scans of the cervical spine from the skull to C7/T1 were enrolled. Fifteen dogs were patients suffering from intervertebral disk herniation (IVDH group), and 15 dogs underwent CT scans due to brachycephalic obstructive airway syndrome (BOAS group).Methods: At the level of each cervical intervertebral disk from C2/C3 to C7/T1, measurements were performed and statistically analyzed. On the sagittal CT scan reconstruction, the height ratio of the dorsal to ventral paraspinal musculature and the angle of the disk axis to vertebral body length were assessed. On the transverse plane, the area ratio of the dorsal and ventral paraspinal musculature and the ratio of force moments were determined at each intervertebral disk level. Finally, ratios were compared to the values of Labrador retrievers and dachshunds published by Hartmann et al. (1).Results: Comparing the two FB groups, one significant difference was detected in the mean height ratio of the dorsal to ventral paraspinal musculature at the level of C5/C6 (P = 0.0092) and C6/C7 (P = 0.0076), with IVDH FBs having the more prominent dorsal paraspinal musculature. At the level of C3/C4, a significantly less prominent dorsal paraspinal musculature in FBs than in dachshunds (P = 0.0058) and a significantly steeper disk to vertebral body angulation were observed (P = 0.0005).Conclusion: Although some incidental differences were found, most parameters did not significantly differ between the BOAS and IVDH FBs. Significant conformational differences in the cervical paraspinal musculature and disk to vertebral body length angulation were found between FBs and two other breeds (chondrodystrophic and non-chondrodystrophic). This study's findings suggest that the paraspinal musculature is an additional biomechanical influencing factor on the preferential sites of IVDH in the cervical spine and that other major factors exist in IVDH development, especially in FBs.

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The FIST Study: Exploring Clinical Strength of Cervical Spine CT in Determining Need for Stabilizing Treatment in Cervical Spine Injury

10.1055/s-0039-1692557 ◽

2019 ◽

Author(s):

B. Y. M. van der Kolk ◽

I. M. Nijholt ◽

M. Podlogar ◽

G. J. Bouma ◽

W. A. van den Brink ◽

...

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Spine Injury ◽

Spine Ct

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