Cervical CT Research Articles

Initial radiation dose reduction studies in cervical spine multidetector CT

Feasibility studies were performed to evaluate the potential for dose reduction when investigating cervical spine trauma using multidetector CT (MDCT), without reducing fracture detectability. The studies utilised both in vitro phantom work and low-dose (LD) clinical images from archive. Test phantoms were constructed using dry human cervical vertebrae suspended inside tissue equivalent material. Vertebrae were modified with fine osteotomies to simulate fracture lines. A LightSpeed VCT 64-slice scanner (GE Healthcare Medical Systems, Milwaukee, WI) was employed to scan the phantom using a series of tube current (mA) settings and constant tube voltage (kVp). The phantom was also scanned using the manufacturer’s programme for automatic tube current modulation (TCM). The recommended TCM tube current table ranges were found to be set to high values (120–600 mA); therefore further modified TCM exposures were made with lower minimum value of 50 mA. Images were assessed under standard clinical review conditions. Low-dose CT series from clinical PET/CT examinations on clinical archive were also evaluated to explore their suitability to visualise cortices and other bony characteristics. Preliminary indications are that image assessments of critical bony features can be achieved with a high degree of confidence when the radiation dose is reduced by a factor of two. Dose Length Product (DLP), was used for relative comparisons between examinations. Using the standard TCM’s DLP as the reference value, bony features were visualised suitably using 60–80 mA and a tube current of 60 mA would lead to a halving of the total DLP to 130 mGy cm. Just reducing the lower limit of the TCM selection range to 50 mA led to a more than 58% reduction in DLP. Our study demonstrates that there is potential for radiation dose reduction during routine clinical imaging for cervical spine trauma and provides supporting evidence for a clinical study.

Anything but a shocking solution – the effectiveness of Cefaly® in non-migrainous headache

Background: The transcutaneous supraorbital nerve stimulation with the Cefaly® device has demonstrated safety and efficacy for the prevention of episodic migraine. However, there isn't description of its efficacy in other headaches. Case report: A 78-year-old man was seen because of a 55-year history of daily headache. His medical history revealed Parkinson's disease, dyslipidemia and mild cognitive impairment. Physical examination revealed bradykynesia and asymmetric resting tremor of both arms, the right more affected than the left. There was mild pain on palpation of both upper trapezius muscles adjacent to the occipital bone. Cervical spine X-ray, CT and MRI: no findings. Various therapeutic approaches were done, but without success, so it was decided to prescribe Cefaly®. At his three-month follow-up, he reported an improvement of about 80%. Conclusion: The case described here shows that Cefaly® may be effective in headaches other than migraine.

Systematic Radiation Dose Reduction in Cervical Spine CT of Human Cadaveric Specimens: How Low Can We Go?

While the use of cervical spine CT in trauma settings has increased, the balance between image quality and dose reduction remains a concern. The purpose of our study was to compare the image quality of CT of the cervical spine of cadaveric specimens at different radiation dose levels. The cervical spine of 4 human cadavers (mean body mass index; 30.5 ± 5.2 kg/m2; range, 24-36 kg/m2) was examined using different reference tube current-time products (45, 75, 105, 135, 150, 165, 195, 275, 355 mAs) and a tube voltage of 120 kV(peak). Data were reconstructed with filtered back-projection and iterative reconstruction. Qualitative image noise and morphologic characteristics of bony structures were quantified on a Likert scale. Quantitative image noise was measured. Statistics included analysis of variance and the Tukey test. Compared with filtered back-projection, iterative reconstruction provided significantly lower qualitative (mean noise score: iterative reconstruction = 2.10/filtered back-projection = 2.18; P = .003) and quantitative (mean SD of Hounsfield units in air: iterative reconstruction = 30.2/filtered back-projection = 51.8; P < .001) image noise. Image noise increased as the radiation dose decreased. Qualitative image noise at levels C1-4 was rated as either "no noise" or as "acceptable noise." Any shoulder position was at level C5 and caused more artifacts at lower levels. When we analyzed all spinal levels, scores for morphologic characteristics revealed no significant differences between 105 and 355 mAs (P = .555), but they were worse in scans at 75 mAs (P = .025). Clinically acceptable image quality of cervical spine CTs for evaluation of bony structures of cadaveric specimens with different body habitus can be achieved with a reference mAs of 105 at 120 kVp with iterative reconstruction. Pull-down of shoulders during acquisition could improve image quality but may not be feasible in trauma patients with unknown injuries.

The radiologic anatomy of thyroid cartilage and cricoid cartilage: implications for anterior cervical spine surgery

Objective To measure anatomic data related to the thyroid cartilage and cricoid cartilage and to analyze their implications for anterior spine surgery. Methods From January 2015 to February 2017, Cervical spine CT image data of 309 normal adults (195 males, 114 females) in our department were retrospectively analyzed. The transverse diameters of the thyroid cartilage and the cricoid cartilage was measured at three different levels as follows: the superior border of the thyroid cartilage(SBTC), the inferior border of the thyroid cartilage(IBTC), and the inferior border of the cricoid cartilage(IBCC). At those levels, the corresponding level and transverse diameter of the cervical vertebra or intervertebral disc were also determined. Differences of anatomic parameters for each gender and level, and the relationship between the transverse diameter and height and weight were analyzed. Results The transverse diameters of the thyroid cartilage or cricoid cartilage and the corresponding cervical vertebra or intervertebral disc were associated significantly with height and weight. The transverse diameters of the thyroid cartilage or cricoid cartilage gradually decreased from the level of SBTC (44.30±4.97 mm) to the level of IBTC (41.39±4.62 mm), and the latter to the level of IBCC (26.36±3.79 mm), but increased from the level of SBTC (27.47±2.66 mm) to the level of IBTC(29.00±3.15 mm), and the latter to the level of IBCC (31.48±3.49 mm) for the cervical vertebra or intervertebral disc. Differences of the transverse diameters of the thyroid cartilage or cricoid cartilage and the cervical vertebra or intervertebral disc on three levels had statistical significance. The transverse diameters of each level had individual differences, while men were greater than those for women. The thyroid cartilage was routinely located above the C5 (56.9% for male, 86.0% for female). Differences of the frequency between men and women on three levels had statistical significance. Conclusion The Individual and sex differences in the location of the thyroid cartilage and the size of the thyroid cartilage and the cricoid cartilage provided anatomical basis for predicting the difficulty of intraoperative exposure, incidence of esophageal injuries and early postoperative dysphagia. Key words: Thyroid cartilage; Cricoid cartilage; Anatomy, regional; Spinal fusion; Deglutition disorders

Rigid Occipitocervical Instrumented Fusion for Atlantoaxial Instability in an 18-Month-Old Toddler With Brachytelephalangic Chondrodysplasia Punctata

Case report. We report here on an 18-month-old boy with brachytelephalangic chondrodysplasia punctata (BCDP), whose atlantoaxial instability was successfully managed with occipitocervical instrumented fusion (OCF) using screw and rod instrumentations. Recently, there have been a number of reports on BCDP with early onset of cervical myelopathy. Surgical OCF is a vital intervention to salvage affected individuals from the life-threatening morbidity. Despite recent advancement of instrumentation techniques, however, rigid OCF is technically demanding in very young children with small and fragile osseous elements. To our best knowledge, this is the first report on application of the instrumentation technique to a toddler patient with BCDP. A 16-month-old boy with BCDP presented with tetraplegia and swallow obstacle. Hypoplasia of the odontoid process and atlantoaxial instability were present in lateral radiographs. T2-weighted magnetic resonance (MR) images revealed a high signal region in the spinal cord at the C1-2 and C7-T1 levels. Cervical computed tomography (CT) showed that the pedicles and lateral masses in the cervical spine were small and immature, but the laminae were comparatively thick. One week before surgery, the patient was fitted with a Halo-body jacket. We performed plate-rod placement with occipital cortical screws and C2/C3 interlaminar screws, and added an autogenous bone graft using the right 8 and 9 ribs. Rigid fixation of the occipito-cervical spine was completed successfully without major complications. Postoperative halo-body jacket immobilization was continued for 3 months, after which Aspen collar was fitted. CT confirmed occipitocervical bone fusion at 6 months after surgery. Mild clinical improvements in motor power of the affected muscles and swallowing were witnessed at 1 year postoperatively. Rigid fixation using screw, rod, and occipital plate instrumentation was successful in an 18-month-old toddler with BCDP and atlantoaxial instability. Bone fusion was achieved at postoperative 6 months. 5.

Acute epidural hematoma due to spinal venous angioma: A case report

Abstract Background Spinal epidural cavernous angioma was reported about 4% of all spinal epidural tumors, mostly generating as a primary lesion in the vertebral bone. Spinal epidural hematoma (SEDH) due to angioma without primary origin was very rare, which reported in the English literatures was only 10 cases including our case. The main symptoms were numbness and pains and motor weakness owing to the acute compression signs of cord and roots. Emergency surgical treatment was required for the good surgical results. We present a rare case of cervical acute epidural hematoma due to ruptured venous angioma. Case presentation A 78-year-old man, who suffered from sudden severe right suboccipitalgia., and sent to our hospital. He also noticed progressive numbness and motor weakness over his bilateral upper and lower extremities after the onset. Cervical CT and MRI showed acute intracanal hematoma over the right side of the cervical spine at C2 to C6. Emergency operation was performed 13 h after the onset. His sensory and motor symptoms were disappeared quickly after the operation. Pathological examination revealed spinal epidural hematoma due to venous angioma. Conclusion This case presented with acute progressive deterioration of paresis and sensory disturbance, and required emergency operation. Early diagnosis and emergency surgical treatment are essential for the therapy of acute spinal epidural hematoma due to venous angioma.

Basion-Cartilaginous Dens Interval: An Imaging Parameter for Craniovertebral Junction Assessment in Children.

Widening of the basion-dens interval is an important sign of cranioverterbral junction injury. The current literature on basion-dens interval in children is sparse and based on bony measurements with variable values. Our goal was to establish the normal values of a recently described new imaging parameter, the basion-cartilaginous dens interval in children. Three hundred healthy pediatric patients (0-10 years of age) were selected retrospectively. These patients were divided into 3 different groups: A (0-3 years), B (3-6 years), and C (6-10 years). The basion-cartilaginous dens interval was calculated on the sagittal MPR image of cervical spine CT in a soft-tissue window. The mean, SD, and the upper limit of normal (mean +2 SDs) of the 3 groups were calculated, and statistical tests were used to check for significant differences of the basion-cartilaginous dens interval among these 3 groups. The upper limits of the basion-cartilaginous dens interval for the 3 groups were 5.34 mm in group A, 5.64 mm in group B, and 7.24 mm in group C. There were statistically significant differences in the basion-cartilaginous dens interval values among the 3 groups. There was no statistically significant difference in basion-cartilaginous dens interval values between groups A and B; however, values in group C were significantly different from those in both A and B. There was no statistically significant difference in the basion-cartilaginous dens interval values between males and females. The basion-cartilaginous dens interval is a novel imaging parameter to assess cranioverterbral junction integrity in children, which includes the nonossified cartilage in the measurement.

Ocular vestibular evoked myogenic potentials (o-VEMPs) testing in cervicogenic vertigo and its relation to radiological findings: a correlation study

Background: The term cervicogenic vertigo is reserved for cases where the suspected mechanism is proprioceptive. For a diagnosis of cervicogenic vertigo, it is essential to exclude other causes of vertigo. Generally, the patient has no hearing complaints and characteristically the symptoms are elicited by neck massage or neck vibration. The ocular vestibular evoked myogenic potential (o-VEMP) is a test for utricular function that has been introduced and validated.Objectives: To assesses o-VEMPs in patients with cervicogenic vertigo using 500 Hz tone bust stimuli at 95 dB nHL. Consequently, correlate the relation between o-VEMPs test results and radiological imaging, in the form of MRI cervical spine and CT angiography of the vertebral artery.Subjects: Fifty two subjects participated in the study; the group comprised 32 patients with diagnosed cervicogenic vertigo and also included 20 healthy matched adults.Methods: A random sample of consenting case and control subjects were obtained. MRI cervical spine with CT angiography of vertebral artery was done with o-VEMPs recordings.Results: Abnormal MRI cervical spines were found in all study group participants. The results for the CT angiography were variable with abnormal o-VEMPs latencies.Conclusion: A link co-exists between utricle and superior vestibular nerve in patients with cervicogenic vertigo. This may play a role in the pathogenesis of vertigo in these affected patients.

P.5.c.006 - Behavioral impairments after intranasal administration of alpha-synuclein oligomers in aged mice

Atlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics.500 adult trauma patients with cervical MDCT at the time of admission were retrospectively selected. ADI, BDI, and TOPSTs were measured by two blinded researchers.488 cervical spine CT scans were reported to be normal and 12 has pathological findings. Mean ADI, BDI and TOPST of C1, C2, C6 and C7 were statistically significantly wider in males. In females, ADI and BDI were significantly narrower with the increase in age. In males, only ADI was significantly narrower, and TOPST of C6 and C7 vertebra were significantly wider with the increase in age. We found the optimal UNLs as follows: ADI 2.5 mm, BDI 8.5 mm, C1 6.5 mm, C2 5.7 mm, C3 6.3 mm (6 mm for C1–3 for practical purposes), C4 11.7 and C5–7 17 mm.We believe that the increase in distances with age may be affected by the height losses of discs and vertebral bodies, formation of anterior osteophytes and regional kyphosis by age. Those results were compatible with the previous reports.

Associated factors of postoperative relapse and metastasis in pT1bN0M0-pT4aN0M0 thoracic esophageal squamous cell carcinoma

To investigate the associated high risk factors of postoperative relapse and metastasis for patients with confined tumors (grade pT1b-4a) without lymph-node metastases (pN0) in thoracic esophageal squamous cell carcinoma (ESCC). Clinicopathological and follow up data of ESCC patients undergoing radical surgical resection as primary treatment in the Department of Thoracic Surgery, Shanghai Chest Hospital between January 2004 and December 2012 from Hospital Database were retrospectively collected. The inclusion criteria were as follows: (1) the first development of ESCC confirmed by histopathology without lymphatic and distant metastasis; (2) pathological stage of pT1bN0M0 to pT4aN0M0 according to the Union for International Cancer Control (UICC) in 2009; (3) curative trans-thoracic esophagectomy with R0 (tumor-free surgical margin) resection, using the Ivor-Lewis or McKeown procedure; two-field lymphadenectomy or three-field lymph node dissection based on the positive results of preoperative cervical ultrasonography examination or CT scan; (4) without adjuvant chemotherapy and/or radiotherapy before and after operation; (5) complete follow-up data. Logistic regression analysis was employed to identify the clinicopathological factors affecting the postoperative relapse and metastasis. A total of 112 patients were eligible, including 94 male cases and 18 female cases; age of (58.6±7.7) years; squamous carcinoma of upper thorax in 25 cases, of middle thorax in 67 cases and of lower thorax segment in 20 cases; 12 cases of high-differentiated ESCC, 49 cases of moderate-differentiated ESCC, poorly-differentiated ESCC in 48 cases; 4 cases of I(a stage, 9 cases of I(b, 24 cases of II(a, 62 cases of II(b, 13 cases of III(a; the tumor length >4 cm in 43 cases, ≤4 cm in 69 cases. Forty-three (38.4%) patients presented relapse or metastasis during the follow-up, including 24 (21.4%) of loco-regional relapse, 13 (11.6%) of distant metastasis, and 6(5.4%) of both above. Multivariate regression analysis revealed that poorly-differentiated tumor (OR=1.899, 95%CI:1.233-2.925, P=0.004), upper-middle location (OR=2.351, 95%CI:1.188-4.653, P=0.014), and tumor length >4 cm (OR=2.381, 95%CI:1.009-5.618, P=0.048) were independent risk factors of overall postoperative relapse and metastasis for thoracic ESCC with stage pT1b N0M0-T4aN0M0. Further stratified analysis identified that only poorly-differentiated tumor (OR=1.730, 95%CI:1.121-2.671, P=0.013) was an independent risk factor of loco-regional relapse, whereas pathological stage II(b-III(a (OR=3.372, 95%CI:1.206-9.428, P=0.021) was an independent risk factor of distant metastasis. Poorly-differentiated tumor, tumor length >4 cm, and upper-middle location may be regarded as high risk factors for predicting overall relapse and metastasis of pN0 thoracic ESCC patients after esophagectomy. Moreover, poorly-differentiated tumor is the only independent risk factor of postoperative loco-regional relapse, meanwhile it should be noted that pathological stage II(b-III(a is closely related to postoperative distant metastasis.

A case of real spinal cord injury without radiologic abnormality in a pediatric patient with spinal cord concussion.

Real spinal cord injury without radiologic abnormality (SCIWORA) is a rare clinical entity. The patient was a 13-year-old girl whose body was overturned anteriorly after crashing her bicycle into a curb. Following the accident, in which her neck and upper back hit the ground, she could not move due to paralysis. On arrival, she had paresis of the bilateral upper extremities and experienced a painful sensation when her upper extremities were touched. Cervical roentgenography and whole-body computed tomography revealed no traumatic lesions in either the intracranium or the cervical bone. Urgent spinal magnetic resonance imaging (MRI) showed no significant spinal cord lesions or spinal canal stenosis. She was put on complete bed rest with a cervical collar. On the 2nd hospital day (24 h after the accident), her motor weakness had almost completely subsided, and she felt only mild dysesthesia in both forearms. Roentgenography revealed no instability. Her motor weakness completely recovered on the third day after accident and she was diagnosed with spinal cord concussion. The present case study, in which MRI was performed, showed that an immediate improvement was obtained in a patient who experienced real SCIWORA. The importance of not only spinal cord lesions, but also perispinal soft tissue injury on MRI has been emphasized for predicting patient outcomes. Accordingly, immediate MRI is essential for evaluating patients with signs and symptoms of spinal cord injury, even when plain neck roentgenography and cervical CT are negative.

Unsuspected osteochondroma-like outgrowths in the cranial base of Hereditary Multiple Exostoses patients and modeling and treatment with a BMP antagonist in mice.

Hereditary Multiple Exostoses (HME) is a rare pediatric disorder caused by loss-of-function mutations in the genes encoding the heparan sulfate (HS)-synthesizing enzymes EXT1 or EXT2. HME is characterized by formation of cartilaginous outgrowths—called osteochondromas- next to the growth plates of many axial and appendicular skeletal elements. Surprisingly, it is not known whether such tumors also form in endochondral elements of the craniofacial skeleton. Here, we carried out a retrospective analysis of cervical spine MRI and CT scans from 50 consecutive HME patients that included cranial skeletal images. Interestingly, nearly half of the patients displayed moderate defects or osteochondroma-like outgrowths in the cranial base and specifically in the clivus. In good correlation, osteochondromas developed in the cranial base of mutant Ext1f/f;Col2-CreER or Ext1f/f;Aggrecan-CreER mouse models of HME along the synchondrosis growth plates. Osteochondroma formation was preceded by phenotypic alteration of cells at the chondro-perichondrial boundary and was accompanied by ectopic expression of major cartilage matrix genes -collagen 2 and collagen X- within the growing ectopic masses. Because chondrogenesis requires bone morphogenetic protein (BMP) signaling, we asked whether osteochondroma formation could be blocked by a BMP signaling antagonist. Systemic administration with LDN-193189 effectively inhibited osteochondroma growth in conditional Ext1-mutant mice. In vitro studies with mouse embryo chondrogenic cells clarified the mechanisms of LDN-193189 action that turned out to include decreases in canonical BMP signaling pSMAD1/5/8 effectors but interestingly, concurrent increases in such anti-chondrogenic mechanisms as pERK1/2 and Chordin, Fgf9 and Fgf18 expression. Our study is the first to reveal that the cranial base can be affected in patients with HME and that osteochondroma formation is amenable to therapeutic drug intervention.

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

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.

USE OF CT FOR ANALYSIS OF THE VERTEBRAL FORAMEN IN THE HOSPITAL OF QUERÉTARO

ABSTRACT Objective: To determine the morphology of the vertebral foramen and its distance to the midline. Methods: Twenty cervical CT scans from the radiographic record of 12 men and 8 women, 18 to 74 years old, of C1 to C6 segments were evaluated, measuring the foramen diameter and its distance to the midline. We look for anomalies of vertebral foramen morphology, using Philips Ingenuity CT equipment with Philips IntelliSpace Portal software. Results: The mean age was 47 years; the segment with the most anomalies was C1, with 10% (increase in foramen diameter), followed by C2 and C6, with 5% (vertebral foramen hypotrophy); the mean diameter of the C1 to C6 segment was 6.081 mm, and the median distance from the midline to the vertebral foramen of C2 to C6 was 13.215 mm. The largest diameter of the vertebral foramen was C2, with a mean of 6.67 mm and the smallest was C4, with a mean of 5.75 mm; the greatest distance from the midline to the vertebral foramen was C1, with a mean of 22.59 mm and the shortest was C4, with a mean of 12.13 mm. Conclusions: The mean diameter of the vertebral foramen and its distance to the midline was determined, setting a safety region for procedures. In our city, there is no study that determines the means of the vertebral foramina diameters, the distance from the midline and its anomalies. It is necessary to rely on CT scans and to make a preoperative plan to avoid complications associated with morphological alterations.

Analysis of clinical diagnosis and treatment in patients with microtia in Klippel-Feil syndrome

To analyze the clinical features and diagnostic and therapeutic procedure of microtia in Klippel-Feil syndrome(KFS),and to summarize the experiences on diagnosis and treatment of this kind of rare disease to avoid misdiagnosing. . Between May 2014 and July 2015,six patients with microtia were diagnosed with suspected cervical vertebral malformation through physical examination and X-ray. Then they underwent additional examinations to evaluate the degree of deformities and relative risks:pure tone test, chest CT,cervical spine CT,temporal CT, echocardiography and ultrasonic on kidney and ureters. Ear reconstruction was performed with soft tissue skin expander and autogenous rib cartilage framework. The six patients were diagnosed as KFS with microtia, which had different degree of cervical fusion and thoracic vertebral fusion. Some of them had rib deformity, scoliosis, congenital renal malformation and so on. Of 6 patients, scar formation occurred in 1 case after ear reconstruction, whose new ears had good position and appearance at 1 month after stage Ⅱ. After operation,6 cases were followed up for 8-20 months (median,12 months),none of them had nerve injury. Five cases had completed the third stage. All of them were well-healed after one month. Three cases were followed up for 3-11 months, the reconstructed ears had a three-dimensional configuration, and the cranioauricular angle of the reconstructed ears were similar to the opposite ears The primary step of comprehensive therapy in microtia with KFS is to diagnose definitely. Enhancing perioperative management can reduce surgery-related risks. It is ought to pay attention to nerve injury in a long-term follow-up.

Clinical and quantitative analysis of patients with crowned dens syndrome

BackgroundCrowned dens syndrome (CDS) is a radioclinical entity defined by calcium deposition on the transverse ligament of atlas (TLA). In this study, the novel semi-quantitative diagnostic criteria for CDS to evaluate the degree of calcification on TLA by cervical CT are proposed. MethodFrom January 2010 to September 2014, 35 patients who were diagnosed with CDS by cervical CT were adopted as subjects in this study. Based on novel criteria, calcium deposition on TLA was classified into “Stage” and “Grade”, to make a score, which was evaluated semi-quantitatively. The correlation between calcification score and CRP level or pain score, and the effects of treatments, such as NSAIDs and corticosteroids, were statistically analyzed. ResultsThe total calcification score from added “Stage” and “Grade” scores demonstrated a significantly strong and linear correlation with CRP level (R2=0.823, **p<0.01). In the multiple comparison test for the treatment effects, significant improvement of the CRP level and pain score were demonstrated after corticosteroid therapy (**p<0.01) compared with NSAIDs. In the conditional logistic regression analysis, the rapid end of corticosteroid therapy was an independent risk factor for relapse of cervico-occipital pain [OR=50.761, *p=0.0419]. ConclusionThe degree of calcification on TLA evaluated by the novel semi-quantitative criteria significantly correlated with CRP level. In the treatment of CDS, it is recommended that a low dosage (15–30mg) of corticosteroids be used as first-line drugs rather than conventional NSAID therapy. Additionally, it is also recommended to gradually decrease the dosage of corticosteroids.

Cervical spine MRI in patients with negative CT: A prospective, multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).

Although cervical spine CT (CSCT) accurately detects bony injuries, it may not identify all soft tissue injuries. Although some clinicians rely exclusively on a negative CT to remove spine precautions in unevaluable patients or patients with cervicalgia, others use MRI for that purpose. The objective of this study was to determine the rates of abnormal MRI after a negative CSCT. Blunt trauma patients who either were unevaluable or had persistent midline cervicalgia and underwent an MRI of the C-spine after a negative CSCT were enrolled prospectively in eight Level I and II New England trauma centers. Demographics, injury patterns, CT and MRI results, and any changes in cervical spine management as a result of MRI imaging were recorded. A total of 767 patients had MRI because of cervicalgia (43.0%), inability to evaluate (44.1%), or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft tissue swelling (4.3%), vertebral disc injury (1.4%), and dural hematomas (1.3%). Rates of abnormal neurological signs or symptoms were not different among patients with normal versus abnormal MRI. (15.2 vs. 18.8%, p = 0.25). The c-collar was removed in 88.1% of patients with normal MRI and 13.3% of patients with an abnormal MRI. No patient required halo placement, but 11 patients underwent cervical spine surgery after the MRI results. Six of the eleven had neurological signs or symptoms. In a select population of patients, MRI identified additional injuries in 23.6% of patients despite a normal CSCT. It is uncertain if this is a true limitation of CT technology or represents subtle injuries missed in the interpretation of the scan. The clinical significance of these abnormal MRI findings cannot be determined from this study group. Therapeutic study, level IV.

The Impact of Radiotherapy in the Treatment of Recurrent Desmoid Tumor of Neck: A Case Report with Literature Review

Background: Extra-abdominal desmoid tumor of the head and neck in particular commonly infiltrate vital neurovascular structures. we report a case of a large and recurrent extra-abdominal desmoid tumor causing significant morbidity and who was treated successfully by radiotherapy. Case presentation: A 34-year-old male patient presented with a history of right neck mass for 15 months, which was gradually increasing in size. Cervical CT scan revealed a large mass of the posterior soft tissues of the neck extended to the soft tissues of the posterior thoracic wall. The CT density of the mass was that of fat tissue. It was measuring 12.4 × 85.9 mm and enhanced after injection of the contrast product. A biopsy was taken. The histopathological findings were suggestive of desmoid tumor. Discussion: This case was discussed in multidisciplinary oncological team and radiotherapy was planned. The surgery was proposed but not performed due to the recurring character of the tumor and the risk of a high postoperative morbidity. After 4 weeks of treatment, the clinical evaluation showed a good response. Conclusion: Alternative treatment modalities such as primary radiotherapy may be preferable to mutilating surgery.

Use Of FIBERGRAFT BG Morsels Mixed With BMA In Anterior Cervical Discectomy And Fusion At 1, 2, 3 And 4 Levels: A Retrospective Analysis Of Fusion Results

Background: Fibergraft material is a synthetic bone graft substitute that has been proven in animal models to reveal 100% fusion in posterolateral spine fusion at 26 weeks. The purpose of this study is to analyze post-op CT scans to evaluate the fusion effectiveness of Fibergraft BG Morsels when combined with bone marrow aspirate (BMA) in one-, two-, three-, and four-level anterior cervical discectomy and fusion (ACDF). Methods: In this retrospective, single-center medical record review, post-op cervical CT scans at approximately six months were evaluated in 27 patients by one senior orthopedic spine surgeon. The surgeon was blinded to the clinical outcomes, patient demographics and past medical history. Fusion results were given a grade of either I, II, III or IV based on the presence of trabecular bridging bone across both graft-vertebral body interfaces. Results: A total of 52 levels were grafted in the 27 subjects who underwent the Smith-Robinson anterior cervical discectomy and fusion. 88.5% of the levels were classified as Grade I complete fusion, 5.8% of the levels classified as Grade II, 3.8% classified as Grade III, and 1.9% classified as Grade IV. Conclusions: Fibergraft BG Morsels mixed with bone marrow aspirate (BA) is an effective bone graft option in one-, two-, three-, and four-level ACDF procedures. This synthetic bioactive glass bone graft substitute combined with BMA achieves high rates of fusion comparable to the biological performance of autologous bone graft.

Normal values of cervical vertebral measurements according to age and sex in CT

IntroductionAtlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics. Methods500 adult trauma patients with cervical MDCT at the time of admission were retrospectively selected. ADI, BDI, and TOPSTs were measured by two blinded researchers. Results488 cervical spine CT scans were reported to be normal and 12 has pathological findings. Mean ADI, BDI and TOPST of C1, C2, C6 and C7 were statistically significantly wider in males. In females, ADI and BDI were significantly narrower with the increase in age. In males, only ADI was significantly narrower, and TOPST of C6 and C7 vertebra were significantly wider with the increase in age. We found the optimal UNLs as follows: ADI 2.5mm, BDI 8.5mm, C1 6.5mm, C2 5.7mm, C3 6.3mm (6mm for C1–3 for practical purposes), C4 11.7 and C5–7 17mm. DiscussionWe believe that the increase in distances with age may be affected by the height losses of discs and vertebral bodies, formation of anterior osteophytes and regional kyphosis by age. Those results were compatible with the previous reports.