Computed tomography of the cervical spine and spinal cord

Development of an evidence-based guideline for imaging in cervical spine trauma

Cervical spine trauma is a common reason for presentation to an emergency department. However, less than 5% of patients who have suffered possible neck injury actually have an injury requiring medical treatment. Nevertheless, the consequences, both for the patient and the doctor, of a missed injury are well recognized by emergency department medical staff. This results in the vast majority of these patients receiving some form of diagnostic imaging. We describe the development of an evidence-based imaging guideline for use in the patient who has suffered cervical spine trauma. The guideline aims to help clinicians determine, at the bedside, when it is appropriate to use imaging and which imaging modality should be used first. Correct utilization of the guideline should lead to a reduction in the number of imaging tests required to reach a diagnosis without adverse patient outcomes.

Intraoperative ultrasonic evaluation of spinal cord motion

The spinal canals of 11 patients with various pathological conditions, both benign and malignant, were examined intraoperatively using real-time ultrasonography. The spinal cords in eight of these patients with lesions causing cord compression were seen to oscillate rhythmically over each mass with a frequency corresponding to the patient's arterial pulsations. The majority of the observed motion was transmitted or extrinsically induced from compression of the anterior spinal artery. In one case, after resection of an anterior cervical neurofibroma, these oscillations diminished markedly. Spinal cord motion, as described, has important implications for neurosurgery, since it contradicts the previously held belief that oscillations of the spinal cord or dura mater imply a "free" or noncompressed spinal cord. Furthermore, spinal cord motion may play a role in the degradation of computerized tomography images of the cord, since these movements are maximized at the areas with the most severe pathology.