Computed Tomography Alone Versus Computed Tomography and Magnetic Resonance Imaging in the Identification of Occult Injuries to the Cervical Spine: A Meta-Analysis

Schoenfeld, Andrew J.; Bono, Christopher M.; McGuire, Kevin J.; Warholic, Natalie M.; Harris, Mitchel B.

doi:10.1097/ta.0b013e3181c0b67a

Cited by 85 publications

(69 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,4 There is published evidence available to support both contentions, although the level of quality in peer-reviewed studies is less than adequate. [1][2][3][4] While acknowledging that MRI can identify injuries missed by MDCT, many physicians argue that such findings are often clinically insignificant and unlikely to alter treatment plans.…”

mentioning

confidence: 89%

“…Those who support the use of adjunct MRI counter that neither the status of the spinal cord nor the integrity of the spinal ligamentous structures can be comprehensively assessed without the use of magnetic resonance technology. 3,4 These physicians believe that the costs of treating a single case of iatrogenic spinal cord injury incurred because of a falsenormal computed tomography far outweigh charges related to the performance of adjunct MRI. The current literature fails to support the use of either imaging protocol as the conclusive diagnostic test for occult spinal trauma.…”

mentioning

confidence: 97%

“…[1][2][3][4] While acknowledging that MRI can identify injuries missed by MDCT, many physicians argue that such findings are often clinically insignificant and unlikely to alter treatment plans. [1][2][3] In their view, the use of MRI needlessly increases health care costs ($1000-$4000 per noncontrast MRI) and places patients at risk of unnecessary interventions, whether surgical or nonoperative. Those who support the use of adjunct MRI counter that neither the status of the spinal cord nor the integrity of the spinal ligamentous structures can be comprehensively assessed without the use of magnetic resonance technology.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical Uncertainty at the Intersection of Advancing Technology, Evidence-Based Medicine, and Health Care Policy

2014

Self Cite

View full text Add to dashboard Cite

mentioning

confidence: 89%

mentioning

confidence: 97%

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical Uncertainty at the Intersection of Advancing Technology, Evidence-Based Medicine, and Health Care Policy

2014

Self Cite

View full text Add to dashboard Cite

“…Several studies have addressed secondary MRI findings when the initial CT scan did not identify cervical instability [8][9][10]26]. A meta-analysis of Schoenfeld [27] including 1,550 patients found injuries in 6 % initially undetected on CT or radiography, but later detected by MRI altering treatment. Recent literature has suggested that MRI may be limited in detecting minor discoligamentous injuries: Brandenstein [28] found a false-negative rate of 0.2 % for unstable cervical spine injuries even though cervical spine clearance was performed by radiographs, CT scan and MRI.…”

Section: Discussionmentioning

confidence: 99%

Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection?

et al. 2013

View full text Add to dashboard Cite

Purpose Recent literature shows that occult discoligamentous injuries still remain difficult to diagnose in the first instance. Thresholds as indicators for discoligamentous segmental instability were previously defined. But, since supine radiodiagnostic is prone to spontaneous reduction of a displaced injury, and even some highly unstable injuries reveal only slight radiographic displacement, these criteria might mislead in the traumatized patient. A highly accurate radiographic instrument to assess segmental motion is the computer-assisted quantitative motion analysis (QMA). The aim was to evaluate the applicability of the QMA in the setting of a traumatized patient. Methods Review of 154 patients with unstable cervical injuries C3-7. Seventeen patients (male/female: 1:5, age: 44.6 years) had history of initially hidden discoligamentous injuries without signs of neurologic impairment. Initial radiographs did not fulfill instability criteria by conventional analysis. Instability was identified by late subluxation/dislocation, persisting/increasing neck pain, and/or scheduled follow-up. For 16 patients plain lateral radiographs were subjected to QMA. QMA data derived were compared with normative data of 140 asymptomatic volunteers from an institutional database. Results Data analysis of measurements revealed mean spondylolisthesis of -1.0 mm (-3.7 to ?3.4 mm), for segmental rotational angle mean angulation of -0.9° ( -11.1°to ?17.7°). Analysis of these figures indicated positive instability thresholds in 5 patients (31.3 %). Analysis of center of rotation (COR)-shifts was only accomplishable completely in 3/16 patients due to limited motion or inadequacy of radiographs. Two of these patients (12.5 %) showed a suspect shift of the COR. Conclusions Our data show a high rate of false negative results in cases of hidden discoligamentous injuries by using conventional radiographic analysis as well as QMA in plain lateral radiographs in a trauma setting. Despite the technical possibilities in a modern trauma center, our data and recent literature indicate a thorough clinical and radiographic follow-up of patients with cervical symptoms to avoid secondary complications from missed cervical spine injuries.

show abstract

“…[15][16][17] A meta-analysis including 11 studies with data from 1,550 patients showed that MRI results altered management in 6% of patients, of whom 5% continued collar immobilization and 1% (12 patients) required surgical intervention. 18 This meta-analysis has been contested, however, 19 because a nonobtunded cohort was included in the analysis. When restricting the findings to obtunded patients with normal neurologic examinations, only 2 of 1,085 patients (0.2%) required operative cervical spine intervention.…”

Section: Discussionmentioning

confidence: 99%

The daunting task of “clearing” the cervical spine

Grunau

Dibski

Hall

2012

CJEM

View full text Add to dashboard Cite

The evaluation of the cervical spine in the emergency department is a common and often challenging task. We report the case of a 70-year-old female who presented intoxicated with evidence of a recent fall. A 64-slice computed tomographic (CT) scan with sagittal and coronal reconstructions revealed no acute injury. The patient was reexamined when alert and had persistent neck pain. Flexionextension static views revealed severe subluxation of C5 on C6 with jumped facets, and subsequent magnetic resonance imaging confirmed significant ligamentous injury. The evidence available suggests that although CT with reconstruction is highly sensitive for clinically significant cervical injury, the possibility of severe injury remains. RÉ SUMÉL'é valuation de la colonne cervicale au service des urgences est une tâ che courante et souvent difficile. Nous signalons le cas d'une femme de 70 ans qui s'est pré senté e aux urgences en é tat d'é brié té et portant des signes d'une chute ré cente. Un tomodensitogramme à 64 coupes par reconstruction frontale et sagittale n'a ré vé lé aucune lé sion aiguë . La patiente, une fois consciente, a é té ré examiné e et souffrait d'une douleur persistante au cou. Des cliché s statiques en flexion-extension ont ré vé lé une subluxation grave de C5 sur C6 et des facettes disloqué es, et un examen subsé quent d'imagerie par ré sonance magné tique (IRM) a confirmé une lé sion ligamentaire importante. Les donné es disponibles permettent de pré sumer que bien que la sensibilité du tomodensitogramme par reconstruction soit é levé e en cas de lé sion cervicale importante sur le plan clinique, la possibilité de lé sion grave demeure.

show abstract

Computed Tomography Alone Versus Computed Tomography and Magnetic Resonance Imaging in the Identification of Occult Injuries to the Cervical Spine: A Meta-Analysis

Abstract: Reliance on CT imaging alone to "clear the cervical spine" after blunt trauma can lead to missed injuries. This study supports a role for the addition of MRI in evaluating patients who are obtunded, or unexaminable, despite a negative CT scan.

Cited by 85 publications

References 24 publications

Clinical Uncertainty at the Intersection of Advancing Technology, Evidence-Based Medicine, and Health Care Policy

Clinical Uncertainty at the Intersection of Advancing Technology, Evidence-Based Medicine, and Health Care Policy

Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection?

The daunting task of “clearing” the cervical spine

Contact Info

Product

Resources

About