Lateral Cervical Spine Radiographs Research Articles

Clinical characteristics of upper cervical spine injuries in children: a retrospective case series.

Pediatric cervical spine injuries (CSI) can be devastating, and children < 8 years are particularly at risk for upper CSI given unique anatomical differences. Diagnosis of these injuries can be delayed due to variable clinical presentations and a paucity of existing literature. The authors aimed to characterize the spectrum of pediatric upper CSI. This was a retrospective, single-center case series of trauma patients aged < 16 years who were assessed at a level I pediatric trauma center and diagnosed with upper CSI between 2000 and 2020. Patients were included if they had evidence of bony or ligamentous injury from the occiput to C2 on imaging or autopsy. Data were obtained from manual chart review and analyzed using descriptive statistics. In total, 502 patients were screened and 202 met inclusion criteria. Of these, 31 (15%) had atlanto-occipital (AO) joint distractions, 10 (5%) had atlanto-axial (AA) joint distractions, 31 (15%) had fractures of C1-2, and 130 (64%) had ligamentous injury without joint distraction. Of the patients with AO injury, 15 patients had complete dislocation. They presented as hemodynamically unstable with signs of herniation and 14 died (93%). In contrast, 16 had incomplete dislocation (subluxation). They usually had stable presentations and survived with good outcomes. Of the patients with AA injury, 2 had complete dislocation, presented with arrest and signs of herniation, and died. In contrast, 8 patients with subluxation mostly presented as clinically stable and all survived with little residual disability. The most common fractures of C1 were linear fractures of the lateral masses and of the anterior and posterior arches. The most common fractures of C2 were synchondrosis, hangman, and odontoid fractures. Overall, these patients had excellent outcomes. Ligamentous injuries frequently accompanied other brain or spine injuries. When these injuries were isolated, patients recovered well. Among upper CSI, AO and AA joint injuries emerged as particularly severe with high mortality rates. Both could be divided into complete dislocations or incomplete subluxations, with clear clinical differences and the former presenting with much more severe injuries. Lateral cervical spine radiography should be considered during resuscitation of unstable trauma patients to assess for these CSI subtypes. Fractures and ligamentous injuries were clinically heterogeneous, with presentations and outcomes depending on severity and associated injuries.

C4 constant vertebra: a novel benchmark of physiological cervical sagittal alignment.

Cervical sagittal alignment is essential, and there is considerable debate as to what constitutes physiological sagittal alignment. The purpose of this study was to identify constant parameters for characterizing cervical sagittal alignment under physiological conditions. A cross-sectional study was conducted in which asymptomatic subjects were recruited to undergo lateral cervical spine radiographs. Each subject was classified according to three authoritative cervical sagittal morphology classifications, followed by the evaluation of variations in radiological parameters across morphotypes. Moreover, the correlations among cervical sagittal parameters, age, and cervicothoracic junction parameters were also investigated. A total of 183 asymptomatic Chinese subjects were enrolled with a mean age of 48.4 years. Subjects with various cervical sagittal morphologies had comparable C4 endplate slope angles under all three different typing systems. Among patients of different ages, C2-C4 endplate slope angles remained constant. Regarding the cervicothoracic junction parameters, T1 slope and thoracic inlet angle affected cervical sagittal parameters, including cervical lordosis and C2-7 sagittal vertical axis, and were correlated with the endplate slope angles of C5 and below and did not affect the endplate slope angles of C4 and above. In general, the slope of the C4 inferior endplate ranges between 13° and 15° under different physiological conditions. In the asymptomatic population, the C4 vertebral body maintains a constant slope angle under physiological conditions. The novel concept of C4 as a constant vertebra would provide a vital benchmark for diagnosing pathological sagittal alignment abnormalities and planning the surgical reconstruction of cervical lordosis.

Comparison of the diagnostic performance of the Swischuk line method and the anterior atlantodental interval method in atlantodental subluxation.

Atlantodental subluxation (ADS) is a serious condition that can result in sudden death. Measuring the anterior atlantodental interval (AADI method) is the gold standard for diagnosis but the complex anatomy of this region can make diagnosis difficult, especially for beginners. Therefore, we would like to use a simpler method, the Swischuk line method, to diagnose ADS. The purpose of our study was to evaluate the diagnostic performance of the Swischuk line method for ADS on lateral cervical spine radiographs compared to the AADI method. A retrospective study was conducted with patients who presented with ADS (ADS group, n = 32, mean age 57.78 years, age range 34-82 years, 10 men, 21 women) and an age- and sex-matched control group (n = 32). The diagnostic performance of the AADI method and the Swischuk line method for ADS was assessed using lateral cervical radiographs in both flexion and neutral postures by an experienced musculoskeletal radiologist (reader 1), a senior resident (reader 2), and a junior resident (reader 3) in the radiologic department. In the flexion posture, the AADI method and the Swischuk line method showed excellent diagnostic performance with AUCs > 0.9 for readers 1 2 and reader 3. In a neutral posture, the diagnostic performance of the AADI and Swischuk line methods was decreased. With a 1mm cut-off value using the Swischuk line method in flexion posture, the sensitivity was 75% or more, the specificity was 100%, and the accuracy was 87.50% or more 90.63% for all readers. With a 2mm cut-off value, the sensitivity was low (37.50-46.88%) but the specificity was 100% for all three readers. In a neutral posture, the sensitivity for both methods decreased, though specificity remained high (> 80%). The Swischuk line method was found to be reliable and showed high sensitivity and specificity with a cut-off value of 1mm for the diagnosis of ADS in cervical lateral radiographs in flexion posture. It can be used as a complement to the AADI method.

“Skip” corpectomy technique in multilevel cervical spondylotic myelopathy and ossified posterior longitudinal ligament: Outcomes with over 10-years follow-up

Objective Skip corpectomy is a surgical technique that includes C4 and C6 corpectomies and fusion via autografts and a cervical plate and is frequently performed in patients with CSM and OPLL. This study presents long-term clinical and radiological outcomes of 48 patients who underwent skip corpectomy with 10-year follow-up. Methods 48 patients who were diagnosed with CSM or OPLL were included. All patients underwent spinal canal decompression and fusion via skip corpectomy. Clinical assessment was performed using the JOA scoring system. The radiological assessment was performed using plain anteroposterior, lateral, and flexion-extension cervical spine radiographs; cervical spine MR imaging; and cervical spine CT scans. The spinal canal size, spinal cord occupation ratio, cervical lordosis, and T2 signal changes were evaluated preoperatively, and postoperatively. Results The mean follow-up period was 14.6 years (13–20 years). Preoperatively, the JOA score was 11.06 ± 3.09. The mean cervical lordosis was 2.08°±11.74 and the average SCOR was 62.1 ± 14.22. There was a significant improvement in SCOR in the early postoperative period. The average cervical lordosis increased to 13.81 ± 2.51 in the 2nd month and minimal loss of cervical lordosis was observed on the 10th year in two patients. Fusion was achieved in all patients, regardless of the graft type. None of the patients had implant failure and graft or hardware-related complications at the 10th-year follow-up. Conclusion Skip corpectomy provides efficient decompression of the spinal cord and provides adequate sagittal alignment and fusion in patients with CSM and OPLL. Long-term radiological and clinical outcomes of the technique are favorable.

Cervical Vertebral Bone Quality Score Independently Predicts Zero-Profile Cage Subsidence After Single-Level Anterior Cervical Discectomy and Fusion

ObjectiveThis is the first study to evaluate the predictive value of the cervical vertebral bone quality (VBQ) score on zero-profile cage (ZPC) subsidence after anterior cervical discectomy and fusion (ACDF) using the HU value of computed tomography (CT) as the reference. MethodsA total of 89 patients with at least 1 year of follow-up who underwent single-level ACDF with ZPC were retrospectively and consecutively included. VBQ and HU value were determined from preoperative T1-weighted MRI and CT. Subsidence was defined as ≥2 mm of migration of the cage into the superior or inferior endplate or both using lateral cervical spine radiography. The results were subjected to statistical analysis. ResultsSubsidence was observed among 16 of the 89 study patients (Subsidence rate:18.0%). The mean VBQ score was 2.94±0.820 for patients with subsidence and 2.33±0.814 for patients without subsidence. The multivariable analysis demonstrated that only an increased VBQ score (OR:1.823, 95%CI: 0.918,3.620, p=0.001) was associated with an increased rate of cage subsidence. There was a significant and moderate correlation between HU and VBQ (r = -0.507, P < 0.001). Using receiver operating characteristic curves, the area under the curve (AUC) was 0.785, and the most appropriate threshold of VBQ was 2.68 (sensitivity 72.7%, specificity 82.1%). ConclusionsThe VBQ score may be a valuable tool for independently predicting zero-profile cage subsidence after single-level ACDF.

Radiological study of foramen arcuale: implications for screw insertion via posterior arch for fixation of C1 vertebrae in atlantoaxial instability using plain radiograph

Abstract Introduction: Foramen arcuale is an osseous structure forming a bridge from the superior articular process of the atlas that completely or partially encircles the vertebral artery. We retrospectively reviewed plain cervical radiographs as suggested by neurosurgeons, neurologists and orthopaedic surgeons for evaluation of cervical spine problems. When foramen arcuale is present, it creates a false impression of a broad posterior arch and can pose a risk during neurosurgery. The aim of this study is to investigate the prevalence of foramen arcuale in the Jalgaon &amp; Baramati population. Materials and Methods: 1255 lateral cervical spine radiographs were obtained from the radiology department, GMC, Jalgaon &amp; GMC Baramati. The patient of which 655 (59.04%) were males and 600(31.42%) were females. Cases were classified as an incomplete and complete bony ridge. Results: Overall prevalence of Foramen arcuale was 8.36%, with complete lesions in 3.50% and incomplete lesions in 4.86%. We noted an increasing percentage of patients with Foramen arcuale from the younger to the adolescent age group, with significantly greater prevalence in patients aged 15-30 years compared with the younger groups. Lesions were more common in males (59.04%) compared with females (31.42%), but no statistically significant difference between genders was detected for complete as well as incomplete foramen arcuale (p=0.95). Conclusion: The foramen arcuale is a relatively common osseous structural variant therefore; surgeons should consider the risk of the presence of an FA prior to procedures on the atlas in each patient. So we suggest the identification of this variant by preoperative lateral radiograph as a starting point for C1 lateral mass for screw fixation via the posterior arch for atlantoaxial instability. If foramen arcuale is suspected or confirmed on a radiograph, 3D CT scanning should be considered for variations in size and shape of foramen arcuale and the possibility of injury to the vertebral artery.

Application of TVD-Net for sagittal alignment and instability measurements in cervical spine radiographs.

Cervical spinal malalignment and instability are frequently occurring pathological conditions involving neck pain, radiculopathy, and myelopathy, often requiring surgical intervention. Accurate assessment of cervical alignment and instability are essential in surgical planning and evaluating postoperative outcomes. To automatically measure the sagittal alignment and instability of the cervical spine, we develop a novel deep-learning model by detecting landmarks on cervical radiographs. We introduce the transformer-embedded residual network (ResNet) as the network's core to automatically identify vertebral landmarks on digital and film-transformed cervical radiographs, and simultaneously measure the segmental Cobb angle and horizontal displacement. A Transformer Module was embedded into the latent space to extract the relationship between different vertebrae. Then a Rotating Attention Module was integrated between the encoder-decoder pairs to highlight the key points and maintain more details. Finally, a Vector Loss Module was proposed to restrain the orientation of the adjacent vertebra to reduce misdetection. All images were obtained from local hospital. Digital images were split into training, validation, and test subsets (896, 225, and 353 images, respectively). Likewise, film-transformed images were split into 404, 115, and 150 images, respectively. The results of the model were compared with manual measurements. Our deep learning algorithm achieved mean absolute difference (MAD) at a level of 2.20° and 2.33°, symmetric mean absolute error(SMAPE)at 16.63% and 19.35%, respectively, when measuring Cobb angle on digital images and films. On evaluating cervical instability, the diagnostic accuracy, sensitivity, specificity, precision, and F1-score evaluation metrics were calculated. The corresponding values were 89.80%, 86.49%, 90.68%, 71.11%, and 78.05% on digital images, and 90.00%, 83.78%, 91.15%, 75.61%, and 79.49% on film-transformed images, which were comparable to experienced surgeons. Visualization results demonstrated robust effectiveness in subjects with severe osteophytes or artifacts. This study presents a novel and efficient deep-learning model to assist landmarks identification and angulation and displacement calculation on lateral cervical spine radiographs, and demonstrates excellent accuracy in measuring cervical alignment and sound sensitivity and specificity in cervical instability diagnosis. It should be helpful for future research and clinical applications.

Is disc height loss at 1 year predictive of pseudarthrosis and patient-reported outcome measures following anterior cervical discectomy and fusion with structural allograft?

The authors sought to determine if postoperative disc height loss is associated with pseudarthrosis following anterior cervical discectomy and fusion (ACDF). They also sought to determine if the amount of postoperative disc height loss is predictive of need for revision for pseudarthrosis, as well as the impact of postoperative disc height loss on patient-reported outcome measures (PROMs) following surgery. The authors retrospectively identified patients aged > 18 years who underwent primary one- to three-level ACDF with allograft at a single institution with 1-year postoperative lateral and flexion-extension cervical spine radiographs. Logistic regression models and receiver operating characteristic curves were used for analysis. Alpha was set at p < 0.05. Anterior or posterior disc height loss ≥ 2 mm was found in 52.5% of patients. Patients with a loss ≥ 2 mm were more likely to develop pseudarthrosis (p = 0.021) but not to undergo revision surgery due to pseudarthrosis (p = 0.459). Multivariable analysis identified male sex (OR 1.66, p = 0.013), the number of levels fused (OR 2.09, p < 0.001), and fusion at C6-7 (OR 1.52, p = 0.043) as predictors of disc height loss. The analysis also revealed that levels at the top (OR 0.383, 95% CI 0.170-0.854, p = 0.020) and middle (OR 0.174, 95% CI 0.053-0.548, p = 0.003) of fusion constructs were significant independent predictors of lower pseudarthrosis rates while disc height loss was not. Patients with disc height loss had significantly less improvement in scores for the Neck Disability Index (p = 0.002), visual analog scale (VAS) for arm pain (p = 0.018), and VAS for neck pain (p = 0.011) at 1 year following surgery. This study is, to the authors' knowledge, the largest study to date to assess the impact of postoperative disc height loss after ACDF. Disc height loss following ACDF was not predictive of revision surgery for pseudarthrosis or overall pseudarthrosis rates. However, pseudarthrosis was less likely to occur at the top and middle of fusion constructs. Loss in disc height postoperatively was significantly associated with less improvement in PROMs.

The Early Effects of Longus Colli Muscle and Anterior Longitudinal Ligament Reconstructions on Swallowing Function after Anterior Cervical Surgery: A Six-Month Follow-Up Study.

Anterior cervical discectomy and fusion (ACDF) is the gold standard surgery used to treat cervical degenerative disease. Dysphagia and hoarseness are the two most common complications that occur after anterior cervical surgery (ACS). In this study, we aim to evaluate the early effects of longus colli muscle (LCM) and anterior longitudinal ligament (ALL) reconstructions on swallowing function after ACS. We recruited 91 patients (35 males and 56 females; mean age: 49.41 ± 8.60 years [range: 26-72 years]) who have undergone either ACDF or anterior cervical corpectomy and fusion (ACCF) between August 2019 and October 2021. Patients were divided into LCM and ALL suture group (Group A), and LCM and ALL non-suture group (Group B). Assessments of the incidence of dysphagia and the swallowing quality of life (SWAL-QOL) were completed in 2 days, 1 week, 1 month, 3 months and 6 months after surgery. Average prevertebral soft tissue thickness (APSTT) were measured on lateral cervical spine radiographs taken with X-rays 2 days, 1 month, 3 months and 6 months after surgery. In the 2-day, 1-week and 1-month postoperative follow-up, the incidence of dysphagia in group A was significantly lower than that in group B (p < 0.05), and the SWAL-QOL scores of group A were significantly higher than those of group B (p < 0.05). In the 3-month and 6-month postoperative follow-up, no significant differences were found between groups A and B in terms of the incidence of dysphagia (p > 0.05). In the 6-month postoperative follow-up, no significant differences were found between the groups in terms of SWAL-QOL scores (p > 0.05). There were no significant differences in APSTT between groups during postoperative follow-up (p > 0.05). The reconstructions of LCM and ALL in ACS can effectively improve short-term postoperative swallowing function.

Clinical significance of the C2 slope after multilevel cervical spine fusion.

The C2 slope (C2S) is one of the parameters that can determine cervical sagittal alignment, but its clinical significance is relatively unexplored. This study aimed to evaluate the clinical significance of the C2S after multilevel cervical spine fusion. A total of 111 patients who underwent multilevel cervical spine fusion were included in this study. The C2S, cervical sagittal vertical axis (cSVA), C2-7 lordosis, and T1 slope (T1S) were measured in standing lateral cervical spine radiographs preoperatively and 2 years after the surgery. Clinical outcome measures were visual analog scale (VAS) neck and arm pain scores, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and patient-reported subjective improvement rate (IR) percentage. Statistical analysis was performed using a paired-samples t-test and Pearson's correlation, and a receiver operating characteristic (ROC) curve to determine the cutoff values of C2S. C2S demonstrated a significant correlation with the cSVA, C2-7 lordosis, T1S, and T1S minus cervical lordosis. C2S revealed a significant correlation with the JOA, neck pain VAS, and NDI scores at 2 years after surgery. Change in the C2S correlated with postoperative neck pain and NDI scores. ROC curves demonstrated the cutoff values of C2S as 18.8°, 22.25°, and 25.35°, according to a cSVA of 40 mm, severe disability expressed by NDI, and severe myelopathy, respectively. C2S can be an additional cervical sagittal alignment parameter that can be a useful prognostic factor after multilevel cervical spine fusion.

Deep-learning model associating lateral cervical radiographic features with Cormack-Lehane grade 3 or 4 glottic view.

Unanticipated difficult laryngoscopy is associated with serious airway-related complications. We aimed to develop and test a convolutional neural network-based deep-learning model that uses lateral cervical spine radiographs to predict Cormack-Lehane grade 3 or 4 direct laryngoscopy views of the glottis. We analysed the radiographs of 5939 thyroid surgery patients at our hospital, 253 (4%) of whom had grade 3 or 4 glottic views. We used 10 randomly sampled datasets to train a model. We compared the new model with six similar models (VGG, ResNet, Xception, ResNext, DenseNet and SENet). The Brier score (95%CI) of the new model, 0.023 (0.021-0.025), was lower ('better') than the other models: VGG, 0.034 (0.034-0.035); ResNet, 0.033 (0.033-0.035); Xception, 0.032 (0.031-0.033); ResNext, 0.033 (0.032-0.033); DenseNet, 0.030 (0.029-0.032); SENet, 0.031 (0.029-0.032), all p < 0.001. We calculated mean (95%CI) of the new model for: R2 , 0.428 (0.388-0.468); mean squared error, 0.023 (0.021-0.025); mean absolute error, 0.048 (0.046-0.049); balanced accuracy, 0.713 (0.684-0.742); and area under the receiver operating characteristic curve, 0.965 (0.962-0.969). Radiographic features around the hyoid bone, pharynx and cervical spine were associated with grade 3 and 4 glottic views.

Diagnostic accuracy of deep learning for evaluation of C-spine injury from lateral neck radiographs

BackgroundTraumatic spinal cord injury (TSI) is a leading cause of morbidity and mortality worldwide, with the cervical spine being the most affected. Delayed diagnosis carries a risk of morbidity and mortality. However, cervical spine CT scans are time-consuming, costly, and not always available in general care. In this study, deep learning was used to assess and improve the detection of cervical spine injuries on lateral radiographs, the most widely used screening method to help physicians triage patients quickly and avoid unnecessary CT scans. Materials and methodsLateral neck or lateral cervical spine radiographs were obtained for patients who underwent CT scan of cervical spine. Ground truth was determined based on CT reports. CiRA CORE, a codeless deep learning program, was used as a training and testing platform. YOLO network models, including V2, V3, and V4, were trained to detect cervical spine injury. The diagnostic accuracy, sensitivity, and specificity of the model were calculated. ResultsA total of 229 radiographs (129 negative and 100 positive) were selected for inclusion in our study from a list of 625 patients with cervical spine CT scans, 181 (28.9%) of whom had cervical spine injury. The YOLO V4 model performed better than the V2 or V3 (AUC = 0.743), with sensitivity, specificity, and accuracy of 80%, 72% and 75% respectively. ConclusionDeep learning can improve the accuracy of lateral c-spine or neck radiographs. We anticipate that this will assist clinicians in quickly triaging patients and help to minimize the number of unnecessary CT scans.

Vertebral Pathology and Vertebrogenic Myelopathy in Patients with Mucopolysaccharoidosis Type IV A (Morquio Syndrome)

Background: Upper cervical spine instability in patients with Morquio´s syndrome is of common occurrence. Dysplastic odontoid is one of the prominent aetiologies behind the development of atlanto-axial instability which eventually leads to morbid vertebrogenic myelopathy. Material and Methods: We describe 10 children (7 boys and 3 girls) with the phenotype/genotype of Morquio´s syndrome (MPS IVA). Lumbar kyphosis occurs at the age of six months, followed by apparent waddling gait at the age of 3 years. Clinical phenotype and genotype are the baseline tools to set up a crystal clear long term management. Firstly, we proceed via clinical assessment of C1-2 instability. The latter is carried out with full dynamic lateral cervical spine radiographs. Instability can be visualized through the precise interpretations of the anatomical structures around the atlanto-axial segments. 3D sagittal CT scan has been applied to further localize the exact pathology. In 7 cases, there was an initial myelopathy at the level of the cranio-vertebral junction. Results: The most threatening complication of MPS IVA is the vertebrogenic myelopathy. The latter emerged as a notorious complication in connection with atlanto-axial instability and progressive thickening of the spinal cord due to accumulation of Glycosaminoglycan (GAGs). Vertebrogenic myelopathy have been encountered in seven children. All underwent decompression and stabilization of the cervical spine Conclusion: Patients with MPS IV, in their first year of life usually manifest growth deficiency and lumbar kyphosis, but unfortunately passed unnoticed by most of the paediatricians. Progressive dysplasia of the acetabulae is the reason behind the waddling gait. The misconception of generalized ligamentous hyper laxity accompanied with waddling gait were the main incentives of confusion among most of the paediatricians and physicians. Thereby, the false diagnosis of Duchenne Muscular dystrophy has been falsely considered by some colleagues. The purpose of this paper is threefold. First, overlooking the early mal-development of the backbone (lumbar kyphosis) is not a simple mistake. Second, marked ligamentous hyperlaxity warrants the attention toward cervical ligaments, and as ligaments are the main supporters of the craniocervical junction and spine stability, such abnormality demands prompt clinical attention. Third, is to assess the vertebral pathology and vertebrogenic myelopathy from the standpoint of syndromic assessment and the efficiency of decompression and stabilization operations.

Correlation between the Photographic Cranial Angles and Radiographic Cervical Spine Alignment.

The cranial vertical angle (CVA) and cranial rotation angle (CRA) are used in clinical settings because they can be measured on lateral photographs of the head and neck. We aimed to clarify the relationship between CVA and CRA photographic measurements and radiographic cervical spine alignment. Twenty-six healthy volunteers were recruited for this study. Lateral photographs and cervical spine radiographs were obtained in the sitting position. The CVA and CRA were measured using lateral photographs of the head and neck. The C2-7 sagittal vertical axis (SVA), cervical lordosis (C2-7), and occipito-C2 lordosis (O-C2) were measured using radiographic imaging as a standard method of evaluating cervical spine alignment. Correlations between the CVA and CRA on photographs and cervical spine alignment on radiographs were analyzed. The CVA and SVA were significantly negatively correlated (ρ = −0.51; p < 0.05). Significant positive correlations were found between CVA and C2-7 (ρ = 0.59; p < 0.01) and between CRA and O-C2 (ρ = 0.65; p < 0.01). Evaluating the CVA and CRA on photographs may be useful for ascertaining head and neck alignment in the mid-lower and upper parts of the sagittal plane.

Deep learning algorithm to evaluate cervical spondylotic myelopathy using lateral cervical spine radiograph

BackgroundDeep learning (DL) is an advanced machine learning approach used in different areas such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is highly advantageous for imaging recognition and classification This study aimed to develop a CNN using lateral cervical spine radiograph to detect cervical spondylotic myelopathy (CSM).MethodsWe retrospectively recruited 207 patients who visited the spine center of a university hospital. Of them, 96 had CSM (CSM patients) while 111 did not have CSM (non-CSM patients). CNN algorithm was used to detect cervical spondylotic myelopathy. Of the included patients, 70% (145 images) were assigned randomly to the training set, while the remaining 30% (62 images) to the test set to measure the model performance.ResultsThe accuracy of detecting CSM was 87.1%, and the area under the curve was 0.864 (95% CI, 0.780-0.949).ConclusionThe CNN model using the lateral cervical spine radiographs of each patient could be helpful in the diagnosis of CSM.

Osteolytic Alteration, Cervical Myelopathy and Dysphonia Associated with Mucoepidermoid Carcinoma: A Case Report

Summary: A vertebral neoplasm of extraosseous origin, is that which affects the vertebra starting from a tissue that has metastized. Clinical diagnosis and imaging only provide an etiopatological approach due to various sources of metastasis, so early obtaining of material for sample analysis and timely treatment becomes important. Objective: This study presents a 62-year-old male patient who manifested dysphonia, respiratory distress, cervical compressive myelopathy syndrome; being as a whole this picture with characteristics of increasing intensity and persistent imaging compatible with osteolysis of the spinous process of the fourth cervical vertebra. Methods: lateral radiographs of preoperative cervical spine and cervical magnetic resonance without contrast in sequences T1 and T2 as well as cervical magnetic resonance without contrast axial cut sequence T2 were evaluated. A week after the diagnosis by image is taken to the operative table where resection of tumor mass associated with cervical paravertebral muscles, C4 laminectomy and exceresis of an extension of the tumor to the spinal canal (extradural) is performed and the anatomopathological study was performed. Results: The patient presented improvement due to recovery of the respiratory bellows in the immediate post-operative period, although dysphonic persisted. The biopsy result reported mucoepidermoid carcinoma. We are interested in highlighting in this case the particular evolutionary association between the respiratory-laryngeal process, cervical osteolytic process and myelopathic manifestations as a regional development of the mucoepidermoid adenocarcinoma tous neoplastic activity.

Association of findings on preoperative extension lateral cervical radiography with osteotomy type, approach, and postoperative cervical alignment after cervical deformity surgery.

The authors' objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2-7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed. On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope. Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

Practice and Perception of Radiographers on the Positioning Techniques of Erect Lateral Cervical Spine Radiography in Non-trauma Adult Patients

Background: The visualization of the lower cervical spine (C-spine), including the C7-T1 junction on lateral radiograph is a challenge due to the overlapping of the shoulder girdle. Therefore, the radiographers have adapted different positioning strategies to overcome this challenge. This study explores the current practice and perception of radiographers on positioning techniques of erect lateral cervical spine radiography in non-trauma adult patients.&#x0D; Methods: This prospective study was conducted with a self-administered, structured questionnaire distributed among 50 radiographers working in four selected hospitals in Sri Lanka.&#x0D; Results: The radiographers used weight-bearing and non-weight-bearing positioning techniques for the erect lateral C-spine radiography. Most of them employed the standing breath-holding technique for image acquisition with or without exertion. While 54% of the radiographers utilized two water-filled cans during the weight-bearing technique, 82% used holding arms back with the shoulders down and pulling as low as possible in the non-weight-bearing technique. In addition, 88% of the radiographers believed that the weight-bearing position could increase the visibility of the C-spine. Almost all the radiographers (100%) stated that correct positioning instruction could improve the visibility of the C-spine.&#x0D; Conclusion: Radiographers have mainly used two positioning techniques of weight-bearing and non-weight-bearing for erect lateral C-spine radiography for non-trauma adult patients. In addition, most radiographers had a positive attitude toward the weight-bearing technique in the evaluation of lateral C-spine. These results highlight the importance of conducting studies to evaluate the effectiveness of the weight-bearing technique in erect lateral C-spine radiography.

P011 Radiological pattern in juvenile onset Spondylarthritis differ from the adult onset spondylarthritis

Abstract Background Spondylarthritis (SpA) is a chronic inflammatory disease of the axial spine that may be affect the peripheral joints. SpA occurs predominantly in adulthood: Adult onset Ankylosing Spondylitis (AoAS). However, it can occur earlier in childhood (≤16 years old), also termed as juvenile onset Ankylosing Spondylitis (JoAS). In the second group, delay in diagnosis may lead to further structural damage. The aim of our study was to compare the differences in radiographic features between JoAS and AoAS. Methods We conducted a retrospective study in our department of rheumatology of Kassab Institute of orthopedics, including patients diagnosed with SpA according to the ASAS criteria (≥17 years at symptom onset) or to the ILAR criteria (≤16 years at symptom onset). Were not included AS patients whose disease onset was ≥ 45 years. Sociodemographic as well as disease characteristics were recorded. The lateral cervical and lumbar spine radiographs were used to assess structural damage by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and The Bath Ankylosing Radiologic Index (BASRI). The total score of mSASSS and BASRI vary between 0–72 and 0–16 respectively with higher scores indicating evolved structural damage. Radiographic features were then compared between AoAS and JoAS. The level of significance was fixed for a P &amp;lt; 0.05. Results Of 140 AS patients, 40 had JoAS and 100 had AoAS. The average age at disease onset was 12.4 ± 3 [8–16] and 25.4 ± 10.1 [17–42] respectively (P &amp;lt; 0.001). The disease duration was 10.6 years [1–44]. The average current age was 25.3 ± 10.2 [9–59] and 32.5 ± 7.5 [18–46] (P &amp;lt; 0.001). The JoAS group showed a more frequent onset with peripheral joint involvement than the AoAS group (80% vs 50%,P = 0.001). Similarly, hip involvement was more frequent among JoAS patients (57.7% vs 25%, P = 0.000). There was no significant differences between the two groups regarding the mean mSASSS score, the total BASRI score and the BASRI score for the sacroiliac joints (P = 0.9, P = 0.49, P = 0.06 respectively). Similarly, there was no differences in the mean spine BASRI score between the two groups, although there was a trend of higher scores among AoAS patients (3.2 vs 3.9, P = 0.15 respectively). On the contrary, JoAS patients had a significantly higher BASRI score for the hip than AoAS patients (2.4 vs 1.3, P = 0.000). Conclusion Our study showed that JoAS patients are more likely to suffer from early hip damage than AoAS patients. The spine BASRI was similar between the two groups despite the shorter disease duration in the juvenile group. This highlights the need for screening for hip involvement and for a closer monitoring in this subset of children.

Cervical spine injury: A review

The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques. MRI and multislice CT technology have made rapid advances. The rapid primary clinical survey should be followed by lateral cervical spine, chest and pelvic radiographs. If a patient is unconscious then CT of the brain and at least down to C3 is very useful. The cranio-cervical scans should be a maximum of 2 mm thickness, and probably less, as undisplaced type II peg fractures, can be invisible even on 1 mm slices with reconstructions. If the lateral cervical radiograph and the CT scan are negative, then MRI is the investigation of choice to exclude instability. Patients with focal neurological deficit, sign of cord or disc injury, and patients whose surgery require pre-operative cord assessment should be imaged by MRI. It is also the investigation of choice for evaluating the complications and late sequela of trauma. If the patient is to have an MRI scan, do a sagittal STIR sequence of the entire vertebral column to exclude non-contiguous injuries, which, since the advent of MRI. Any areas of oedema or collapse then require detailed CT scanning. The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques.