Assessment Of Cervical Spine Injuries Research Articles

An assessment of cervical spine injury associated with maxillofacial trauma: A retrospective study of 3 years

An assessment of cervical spine injury associated with maxillofacial trauma: A retrospective study of 3 years

Role of magnetic resonance imaging in assessment of cervical spine injuries and clinico-neurological outcome at tertiary care centre

Role of magnetic resonance imaging in assessment of cervical spine injuries and clinico-neurological outcome at tertiary care centre

Expert Evidence in Whiplash Injury

The assessment of cervical spine injuries is not a problem - provided full evidence of primary physical damage can be ensured. MRI examinations of the cervical spine carried out soon after the accident provide the best evidence. The assessment is more difficult if only clinical abnormalities are documented by the doctors after the accident in the diagnosis of cervical spine distortion, as functional results of this type are not specific and are also common in the general population. The legal rules of evidence must be taken into account in the summary assessment of the consequences of cervical spine injuries. Testing schemes are available which allow structured assessment of cervical spine injuries and help to avoid incorrect assessments.

Comprehensive computed tomography assessment of the upper cervical anatomy: what is normal?

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.

Vestibular evoked myogenic potentials (VEMPs) in whiplash injury: a prospective study

Conclusions. Patients affected by whiplash-associated disorder presented alterations of vestibular evoked myogenic potentials (VEMPs). VEMP testing may be an important ‘forensic’ diagnostic tool in the assessment of cervical spine injury. Objectives. The purpose of this prospective study was to evaluate changes in VEMPs in the assessment of whiplash injuries. Patients and methods. Fourteen patients complaining of whiplash injury were examined and compared with 15 controls. All patients underwent VEMP testing within 7 days from the injury and 90 days after whiplash injury. Beside VEMPs, standard investigation consisted of pure-tone and speech audiometry, impedance audiometry and evaluation of the vestibular system. Results. All subjects presented normal hearing, normal impedence audiometry findings, and normal vestibular function. VEMPs were present both in patients affected by whiplash injury and in the control group at time 0. At 90 days VEMPs were absent in two cases (14.3%). Statistical analysis showed that at time 0 and at time 90 days p1 latency was significantly higher in whiplash patients compared with healthy subjects on both sides (p<0.002). The amplitude of p1–n1 was significantly lower in whiplash patients at time 0 (p = 0.003 on the right and p = 0.018 on the left), but not at 90 days.

An Evidenced-Based Approach to Radiographic Assessment of Cervical Spine Injuries in the Emergency Department

The modern approach to suspected cervical spine injuries is highly dependent on appropriate utilization of radiographic studies. Clinical decision rules have been developed for determination of those most likely to benefit from plain film studies, but there is confusion regarding those who should undergo computed tomography (CT) scanning. This case-based review highlights current available evidence and provides a framework to guide emergency medicine providers in the treatment of patients with trauma to the cervical spine.

Uncovertebral joint injury in cervical facet dislocation: the headphones sign

The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries.

The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency department.

To determine if the use of a modified adult protocol that uses cervical spine imaging on presentation for the assessment of cervical spine injury in children improves clinical outcome. This is a case series study on all consecutive trauma patients presenting from April to July 2000 inclusive to the ED of a major paediatric trauma hospital. Children presenting to the ED with potential cervical spine injury (CSI) were identified using standard selection criteria. Patient demographics, mechanism of injury, method and time of presentation, associated injuries, radiological investigation and clinical outcome were recorded. The major outcome measures for this study were: time to clearance of the cervical spine, length of stay in the ED and admission to an in-hospital bed. Data were analysed for compliance to the protocol, this being the standard assessment pathway of cervical spine clearance used by our trauma service. The trauma registry identified 1721 trauma presentations during the 4-month study period; 208 presentations representing 200 children with potential CSI were entered into the study. Males represented 72.5% of the study population, having a mean age of 8.32 years, although 29% were less than 5 years of age. The majority of presentations (69%) occurred outside of normal working hours. In 17.8% of cases the cervical spine was cleared based on clinical assessment alone, half less than 5 years of age. Compliance to the protocol occurred in 78% of presentations. However, when examined by age group, children 5 years of age or above were 1.5 times more likely to comply with the protocol as compared with younger children. Adequate plain imaging was not obtained in 18% of presentations, this group almost exclusively less than 5 years of age. There were no missed injuries and no short or long-term neurological sequelae reported during this study. There were no differences in time to clearance, length of stay and admission rate between compliant and non-compliant groups. Modified adult protocols for cervical spine clearance offer guidance in managing the majority of children suffering blunt trauma. However, we recommend caution in rigidly applying such protocols, especially to children of young age.

The role of helical CT in the assessment of cervical spine injuries.

The role of helical CT in the assessment of cervical spine injuries.D B Nuñez, Jr and R M QuencerAudio Available | Share

Trauma radiology: Part V. Imaging of acute cervical spine trauma.

Cervical spine injury constitutes a major cause of morbidity resulting from trauma. The consequences of a missed "significant" injury can be devastating for the patient and can create potential medical legal consequences for involved physicians. Multiple imaging modalities can be applied to imaging of the cervical spine after trauma, including radiography, computed tomography (CT), myelography, CT myelography and magnetic resonance imaging (MRI). Controversy exists concerning the appropriate number of radiographic views required for the screening assessment of cervical spine injuries. CT clarifies uncertain radiological findings, identifies subtle fractures in patients with neck pain or with neurological deficits but with normal radiographs, determines details of injury, and assists in operative planning. MRI has virtually replaced myelography and CT myelography in evaluating the traumatized cervical spine. MRI is more accurate than CT with intrathecal contrast in delineating epidural pathology, ligament injury, soft-tissue edema, and cord parenchymal injury. Information derived from MRI guides appropriate management and has value in predicting injury outcome. We consider indications for and relative merits of these various diagnostic modalities, and we describe imaging features of major patterns of cervical spine injury.