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Yamamoto S, Whyte T, Van Toen C, Melnyk A, Shewchuk J, Street J, Cripton P, Oxland TR. The diagnostic precision of computed tomography for traumatic cervical spine injury: An in vitro biomechanical investigation. Clin Biomech (Bristol, Avon) 2022; 92:105529. [PMID: 35032901 DOI: 10.1016/j.clinbiomech.2021.105529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND CT is considered the best method for vertebral fracture detection clinically, but its efficacy in laboratory studies is unknown. Therefore, our objective was to determine the sensitivity, precision, and specificity of high-resolution CT imaging compared to detailed anatomic dissection in an axial compression and lateral bending cervical spine biomechanical injury model. METHODS 35 three-vertebra human cadaver cervical spine specimens were impacted in dynamic axial compression (0.5 m/s) at one of three lateral eccentricities (low 5% of the spine transverse diameter, middle 50%, high 150%) and two end conditions (19 constrained lateral translation and 16 unconstrained). All specimens were imaged using high resolution CT imaging (246 μm). Two clinicians (spine surgeon and neuroradiologist) diagnosed the vertebral fractures based on 34 discrete anatomical structures using both the CT images and anatomical dissection. FINDINGS The sensitivity of CT was highest for fractures of the facet joint (59%) and vertebral endplate (57%), and was lowest for pedicle (13%) and lateral mass fractures (23%). The precision of CT was highest for spinous process fractures (83%) and lowest for pedicle (21%), uncinate process and lateral mass (both 23%) fractures. The specificity of CT exceeded 90% for all fractures. The Kappa value between the two reviewers was 0.52, indicating moderate agreement. INTERPRETATION In this in vitro cervical spine injury model, high resolution CT scanning missed many fractures, notably those of the lateral mass and pedicle. This finding is potentially important clinically, as the integrity of these structures is important to clinical stability and surgical fixation planning.
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Affiliation(s)
- Shun Yamamoto
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; Department of Orthopaedic Surgery, Jikei University Graduate School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Tom Whyte
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Carolyn Van Toen
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Angela Melnyk
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Jason Shewchuk
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W. 12(th) Ave., Vancouver, BC V5Z 1M9, Canada
| | - John Street
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Peter Cripton
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
| | - Thomas R Oxland
- Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.
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Tanishima S, Mihara T, Ogawa S, Takeda C, Fujiwara S, Nagashima H. Bilateral facet effusion is a risk factor for segmental instability with cervical injury without vertebral fracture. Sci Rep 2021; 11:12531. [PMID: 34131235 PMCID: PMC8206338 DOI: 10.1038/s41598-021-91981-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
Magnetic resonance imaging (MRI) is effective in identifying cervical spine injury after trauma. However, cervical instability without major bone injury or dislocation is challenging to assess. Hence, the current study aimed to investigate and compare the MRI and radiography findings of segmental instability in patients with cervical spine injury. We investigated 34 participants with cervical spine injury without vertebral fracture. Based on the radiography findings, the participants were categorized into two: group A with segmental instability (n = 11) and group B without segmental instability (n = 23). Both groups were compared in terms of the presence of segmental instability on radiography and MRI. Anterior longitudinal ligament (ALL) injury, disc injury, and bilateral facet effusion were observed in 6/11, 5/11, and 7/11 patients in group A and in 5/23, 2/23 and 7/23 patients in group B, respectively. The results showed significant differences (p < 0.05). Moreover, 2 and 10 of 11 patients in group A and 16 and 7 of 23 patients in group B presented with hemi lateral facet effusion and paravertebral muscle injury, respectively. However, the results did not significantly differ. According to a logistic regression analysis, bilateral facet effusion after trauma was associated with cervical segmental instability (odd ratio: 10.6, 95% confidence interval: 1.31–84.7). Facet joint effusion might be caused by capsule injury during trauma. Most participants with segmental instability had ALL, disc, and flavum injury and bilateral facet effusion. Therefore, we need to consider bilateral facet effusion with other soft tissue damage of the cervical spine as an association factor to show the instability.
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Affiliation(s)
- Shinji Tanishima
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan.
| | - Tokumitsu Mihara
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Shinya Ogawa
- Department of Orthopedic Surgery, Japanese Red Cross Masuda Hospital, Masuda, Shimane, 698-8501, Japan
| | - Chikako Takeda
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
| | - Satoshi Fujiwara
- Department of Orthopedic Surgery, Sanin Rosai Hospital, Yonago, Tottori, 683-0002, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory of Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, 683-8504, Japan
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