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Azizi N, Huynh JL, Raslan O, Bobinski M, Hacein-Bey L, Ozturk A. Pediatric cervical spine clearance after blunt trauma and negative CT: What is the role of MRI? J Neuroradiol 2024; 51:101206. [PMID: 38801971 DOI: 10.1016/j.neurad.2024.101206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND PURPOSE The cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of spinal injury, and consequently to different X-ray and computed tomography (CT) imaging recommendations. Magnetic resonance imaging (MRI) has been validated to clear cervical spine trauma in adults, but not in pediatric patients. We hypothesized that MRI findings have a low probability to change management in children with spine trauma and negative CT findings. MATERIALS AND METHODS We reviewed records for admitted pediatric patients due to blunt trauma from January 2011 to May 2021, and identified 212 patients who underwent MRI within 3 days of a negative CT. Two neuroradiologists independently reviewed all CT and MRI images for the following categories: fracture, subluxation, spinal canal compromise, ligamentous injury, spinal canal hemorrhage, cord contusion and soft tissue hemorrhage. We identified follow-up MRI examinations as negative or positive for the above categories, and calculated the prevalence of each category as a percentage of cases with negative CT. We also evaluated whether negative and positive MRI groups differed significantly with respect to age and sex of the patients. RESULTS AND CONCLUSIONS In our study of 212 children with cervical spine trauma and a negative CT, most follow-up MRI scans were found to be negative (79.9 %). Positive MRI findings consisted mainly of ligamentous sprain without disruption (15.1 %). Ligamentous disruption and epidural or soft tissue hemorrhage were found in 4.5 %, and focal cord contusion in 0.5 %. There was no statically significant difference between negative and positive MRI groups with respect to age (P = 0.45) and sex (P = 0.52). CONCLUSION In our patient group with a negative CT, MRI did not significantly impact management nor contribute to cervical spine clearance in children.
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Affiliation(s)
- Nazanin Azizi
- University of California Davis, Department of Radiology, Neuroradiology Division, Sacramento, CA, USA
| | - Jimmy L Huynh
- University of California Davis, Department of Radiology, Neuroradiology Division, Sacramento, CA, USA
| | - Osama Raslan
- University of California Davis, Department of Radiology, Neuroradiology Division, Sacramento, CA, USA
| | - Matthew Bobinski
- University of California Davis, Department of Radiology, Neuroradiology Division, Sacramento, CA, USA
| | - Lotfi Hacein-Bey
- University of California Davis, Department of Radiology, Neuroradiology Division, Sacramento, CA, USA
| | - Arzu Ozturk
- University of California Davis, Department of Radiology, Neuroradiology Division, Sacramento, CA, USA.
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Cirillo JI, Ricciardi GA, Alvarez Lemos FL, Guiroy A, Yurac R, Schnake K. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm. EFORT Open Rev 2024; 9:202-209. [PMID: 38457922 PMCID: PMC10958245 DOI: 10.1530/eor-23-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.
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Affiliation(s)
- Juan Ignacio Cirillo
- Hospital del Trabajador, Santiago, Chile
- Clínica Universidad de los Andes, Santiago, Chile
- Universidad Andrés Bello, Hospital del Trabajador, Facultad de Medicina, Santiago, Chile
| | - Guillermo A Ricciardi
- Centro Médico Integral Fitz Roy, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
- Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina
| | | | | | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - AO Spine Latin America Trauma Study Group
- Hospital del Trabajador, Santiago, Chile
- Clínica Universidad de los Andes, Santiago, Chile
- Universidad Andrés Bello, Hospital del Trabajador, Facultad de Medicina, Santiago, Chile
- Centro Médico Integral Fitz Roy, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
- Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina
- Hospital Roberto del Río, Santiago, Chile
- Elite Spine Health and Wellness Center, Florida, USA
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
- Center for Spinal and Scoliosis Surgery, Malteser Waldrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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Ismail R, Manganaro M, Schartz D, Worley L, Kessler A. A pictorial review of imaging findings associated with upper cervical trauma. Emerg Radiol 2023:10.1007/s10140-023-02141-w. [PMID: 37254028 DOI: 10.1007/s10140-023-02141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
The diagnosis of cervical spine injury in the emergency department remains a critical skill of emergency room physicians as well as radiologists. Such diagnoses are often associated with high morbidity and mortality unless readily identified and treated appropriately. Both computed tomography (CT) and magnetic resonance imaging (MRI) often are crucial in the workup of spinal injury and play a key role in arriving at a diagnosis. Unfortunately, missed cervical spine injuries are not necessarily uncommon and often precede detrimental neurologic sequalae. With the increase in whole-body imaging ordered from the emergency department, it is critical for radiologists to be acutely aware of key imaging features associated with upper cervical trauma, possible mimics, and radiographic clues suggesting potential high-risk patient populations. This pictorial review will cover key imaging features from several different imaging modalities associated with upper cervical spine trauma, explore patient epidemiology, mechanism, and presentation, as well as identify confounding radiographic signs to aid in confident and accurate diagnoses.
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Affiliation(s)
- Rahim Ismail
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Mark Manganaro
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Derrek Schartz
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Logan Worley
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Alexander Kessler
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Cao J, Xie N, Qian P, Hu M, Tu J. Feasibility analysis of high pitch cervical spine CT in uncooperative patients with acute cervical spine trauma: An initial experience. Medicine (Baltimore) 2022; 101:e30785. [PMID: 36181071 PMCID: PMC9524935 DOI: 10.1097/md.0000000000030785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Cervical computed tomography (CT) often suffers from examination failure in uncooperative patients with acute cervical spinal trauma. Therefore, this study aimed to evaluate the feasibility of using high-pitch cervical CT (HP-CT) in such populations. A total of 95 patients with acute neck/head-neck trauma who underwent HP-CT (n = 29) or standard cervical CT (SD-CT, n = 66) from October 2020 to June 2021 were included in this study. Differences in patient characteristics between the HP-CT group and the SD-CT group were firstly compared. Then, the objective image quality based on the mean score of the signal-to-noise ratio (SNR)/contrast noise ratio (CNR) was evaluated, while double-blind five-point scoring was adopted for the subjective evaluation. Finally, radiation doses in HP-CT and SD-CT were compared. Furthermore, the Student t test and/or Mann-Whitney U test were performed to analyze differences in patient characteristics, image quality, and radiation dose between the two regimes. A total of 17 cases of cervical spine fractures were found in 95 patients, including 6 cases in the HP-CT group and 11 cases in the SD-CT group. The average age of patients who received HP-CT was higher than that of those who received SD-CT, and the scan time using HP-CT was shorter than that SD-CT. The differences were statistically significant (both, P < .05). In addition, there was no significant difference between HP-CT and SD-CT in terms of sex, body mass index, field of view (FOV), and scan length (all P > .05). The SNR/CNR at the middle and upper neck was not significantly different between HP-CT and SD-CT (all P > .05). However, the SNR/CNR at the lower neck in HP-CT was lower than that in SD-CT (all P < .05). There was no significant difference in the subjective scores between HP-CT and SD-CT images in both the soft tissue and bone window (P = .129 and 0.649, respectively). The radiation dose in HP-CT was lower than that in SD-CT (all P < .05). With a scan time reduction of 73%, radiation dose reduction of 10%, and similar image quality, high-pitch cervical CT was of feasibility to evaluate cervical spine injury in uncooperative patients with acute cervical spine trauma.
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Affiliation(s)
- Juntao Cao
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu Province, China
| | - Na Xie
- Department of Medical Imaging, Kunshan Maternal and Child Health Hospital, China
| | - Pingkang Qian
- Trauma Center, Kunshan Hospital of Traditional Chinese Medicine, China
| | - Ming Hu
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu Province, China
| | - Jianchun Tu
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu Province, China
- *Correspondence: Jianchun TU, Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine. No. 189, Chaoyangxi Road, Kunshan City 215300, Jiangsu Province, China (e-mail: )
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Culhane J, Parr A, Mercier P. Accuracy of ct evaluation for cervical spine clearance in the ground level fall population - a retrospective cohort study. BMC Emerg Med 2022; 22:106. [PMID: 35690715 PMCID: PMC9188238 DOI: 10.1186/s12873-022-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Clinically occult cervical spine (CS) injuries are well described in blunt trauma, however delay in identifying these injuries and clearing the CS can result in morbidity. Our study examines the ground level fall (GLF) population to analyze whether computed tomography (CT) alone can rule out unstable injury in this group with lower force mechanism. Methods This is a single center, retrospective cohort study. All GLF patients in the institutional trauma registry between 6/1/2012 through 12/31/2019 were included. These comprise all trauma patients evaluated in the emergency department with Injury Severity Score (ISS) > 0, including both activations and consults with both clinical and radiological spine evaluation. Patients who could not be cleared by National Emergency X-ray Utilization Study (NEXUS) criteria underwent CT. Patients with CT or clinical suspicion of cord or ligamentous injury underwent MRI. CT occult injuries were identified by MRI and clinical exam, with MRI identifying all unstable injuries. Results Sixty-nine (2.0%) of patients had CS injury without acute CT abnormality. Of these, 11 (0.3%) required surgery and were considered unstable. All patients who required surgery had a neurologic deficit. Negative predictive value (NPV) of CT for unstable CS injury was 99.7%. The combination of acute CT findings and neurologic deficit ruled out unstable CS injury with 100% NPV. Conclusion In the GLF population, CT alone rules out unstable CS injury with high, but not perfect NPV. The combination of absence of acute CT findings and acute neurologic deficits rules out unstable CS injury with 100% NPV. Supplementary information The online version contains supplementary material available at 10.1186/s12873-022-00657-x.
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Affiliation(s)
- John Culhane
- Saint Louis University School of Medicine, Saint Louis, MO, USA. .,Departments of Trauma and Neurosurgery, Saint Louis University, Saint Louis, MO, USA. .,Department of Surgery, Saint Louis University, 1008 Spring Ave, Saint Louis, MO, 63110, USA.
| | - Alan Parr
- Saint Louis University School of Medicine, Saint Louis, MO, USA.,Departments of Trauma and Neurosurgery, Saint Louis University, Saint Louis, MO, USA.,Department of Surgery, Saint Louis University, 1008 Spring Ave, Saint Louis, MO, 63110, USA
| | - Philippe Mercier
- Saint Louis University School of Medicine, Saint Louis, MO, USA.,Departments of Trauma and Neurosurgery, Saint Louis University, Saint Louis, MO, USA.,Department of Neurosurgery, Saint Louis University, 1008 Spring Ave, Saint Louis, MO, 63110, USA
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Benchetrit S, Blackham J, Braude P, Halliday R, Shipway D, Williams A, Carlton E. Emergency management of older people with cervical spine injuries: an expert practice review. Emerg Med J 2021; 39:331-336. [PMID: 34344732 DOI: 10.1136/emermed-2020-211002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
Spinal fractures are the third most common traumatic injury in older people, of which cervical spine injuries make up around 15%. They are predominantly seen in people living with frailty who fall from standing height. Spinal fractures in this patient group are associated with substantial morbidity and mortality (over 40% at 1 year). For many older people who survive, their injuries will be life changing. Practice between EDs varies significantly, with no universally accepted guidelines on either assessment, investigation or management specific to older people experiencing trauma. This expert practice review examines the current evidence and emergency management options in this patient group through clinical scenarios, with the aim of providing a more unified approach to management.
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Affiliation(s)
| | | | - Philip Braude
- Department of Medicine for Older People, Southmead Hospital, Bristol, UK
| | - Ruth Halliday
- Trauma & Orthopaedic Research Team, Southmead Hospital, Bristol, UK
| | - David Shipway
- Department of Medicine for Older People, Southmead Hospital, Bristol, UK
| | - Adam Williams
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
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Leonardo F, Galindo GFDC, Pagamisse OST, Rodrigues JMDS. ALGORITHMS FOR CLINICAL ASSESSMENT OF THE CERVICAL SPINE IN PATIENTS WITH SEVERE TRAUMA: A MIXED-METHOD ANALYZIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212002242209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Cervical trauma is an important cause of morbidity and mortality, affecting 2% of patients admitted to emergency units. Therefore, this study aims to compare the use of two clinical cervical spine evaluation algorithms, the Canadian C-Spine Rule (CCR) and the National Emergency X-radiography Utilization Study (NEXUS). Methods: A descriptive study of the use of the two algorithms by medical residents in the initial assessment of severely traumatized patients admitted to the regional emergency unit was conducted. The evaluation of the indication for imaging tests and the positive predictive value of the algorithms were the parameters analyzed. Finally, the residents answered a questionnaire evaluating the applicability, degree of confidence and advantages of both flowcharts. Results: There was no significant difference between the number of indications for imaging or their predictive values. In the analysis of the questionnaires, the CCR proved to be more reliable and the NEXUS more applicable, and the positive and negative points of applying each of them were highlighted. Conclusion: It is concluded that the two methods are similar in detecting injuries and optimizing the use of imaging exams, being equally indicated to evaluate cervical trauma. However, the technical specifics of each must be taken into account when deciding which to use. Level of evidence IV; Descriptive Study.
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