Diagnostic accuracy of flexion‐extension radiography for the detection of ligamentous cervical spine injury following a normal cervical spine computed tomography

Oh, Jason Jaeseong; Asha, Stephen Edward; Curtis, Kate

doi:10.1111/1742-6723.12612

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…In addition, it was difficult to observe the C7/T1 motion segment in dynamic radiography for comatose trauma patients. Oh found that flexion–extension radiography did not contribute additional diagnostic accuracy for the detection of ligamentous injury to the cervical spine following a normal CT. It was, therefore, recommended that flexion–extension radiography should be removed from cervical spine clearance protocols.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Cervical Kinematic Magnetic Resonance Imaging in Patients with Cervical Spinal Cord Injury without Fracture and Dislocation

Bao

Zhong

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the feasibility and safety of cervical kinematic MRI (KMRI) in patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD).Methods: This was a single-institution case-only study. Patients with CSCIWFD were enrolled in our institution from February 2015 to July 2019. Cervical radiography and CT were performed first to exclude cervical tumors, and major fracture or dislocation. Then neutral static and kinematic (flexion and extension) MRI was performed for patients who met the inclusion criteria under the supervision of a spinal surgeon. Any adverse events during the KMRI examination were recorded. Patients received surgical or conservative treatment based on the imaging results and patients' own wishes. The American Spinal Injury Association impairment scale (AIS) grade and the Japanese Orthopedic Association (JOA) score were evaluated on admission, before KMRI examination, and after KMRI examination. For the surgical patients, AIS grade and JOA score were evaluated again 1 week after the operation. The JOA scores were compared among different time points using the paired t-test.Results: A total of 16 patients (12 men and 4 women, mean age: 51.1 [30-73] years) with CSCIWFD were included in the present study. Clinical symptoms included facial trauma, neck pain, paraplegia, paresthesia, hyperalgesia, sensory loss or weakness below the injury level, and dyskinesia. On admission, AIS grades were B for 2 cases, C for 5, and D for 9. A total of 14 patients underwent neutral, flexion, and extension cervical MRI examination; 2 patients underwent neutral and flexion examination because they could not maintain the position for a prolonged duration. No patient experienced deterioration of neurological function after the examinations. The AIS grades and JOA scores evaluated post-examination were similar to those evaluated pre-examination (P > 0.05) and significantly higher than those on admission (P < 0.05). A total of 12 patients received surgical treatment, 11 of whom underwent anterior cervical discectomy and interbody fusion and 1 underwent posterior C3/4 fusion with lateral mass screws. The remaining 4 patients were offered conservative therapy. None of the patients experienced any complications during the perioperative period. The AIS grade did not change in most surgical patients, except that 1 patient changed from grade C to D 1 week after the operation. The JOA score 1 week after surgery was significantly higher than those on admission and around examination for the surgical patients (P < 0.05).Conclusion: Cervical KMRI is a safe and useful technique for diagnosis of CSCIWFD, which is superior to static cervical MRI for therapeutic decision-making in patients with CSCIWFD.

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Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Cervical Kinematic Magnetic Resonance Imaging in Patients with Cervical Spinal Cord Injury without Fracture and Dislocation

Bao

Zhong

Zhu

et al. 2020

Orthopaedic Surgery

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“…die Auswirkungen auf die segmentale Stabilität schwer zu beurteilen [17]. In diesen Fällen kann die geführte seitliche Durchleuchtung unter Bildwandler eine mögliche Instabilität darstellen, der zusätzliche Nutzen dieser Untersuchungstechnik wird in der Literatur allerdings sehr kritisch betrachtet [18,19,20]. Um falsch negative Befunde zu minimieren, sollte eine solche Durchleuchtung immer unter suffizienter Analgesie unter Fixierung der Schultern durch einen in dieser Untersuchungstechnik versierten Arzt erfolgen.…”

Section: Diagnostikunclassified

Verletzungen der subaxialen Halswirbelsäule

Schleicher,

Pingel,

Neuhoff

et al. 2024

Die Wirbelsäule

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ZusammenfassungDie untere Halswirbelsäule (HWS) ist anfällig für Verletzungen, die 2,5–5% aller knöchernen Verletzungen ausmachen. Statistiken zeigen, dass 20–50% aller Wirbelsäulenverletzungen die HWS betreffen, wobei 50–70% auf die untere HWS entfallen. In Deutschland gab es 2018 rund 11.528 stationäre Behandlungen aufgrund von Halswirbelsäulenfrakturen, mit steigender Tendenz.Rückenmarkverletzungen bei HWS-Verletzungen treten mit etwa 10–12% auf, wobei das Risiko im Vergleich zu Brust- und Lendenwirbelverletzungen dreifach höher ist. Sportliche Aktivitäten, Verkehrsbeteiligung und Stürze über 2 m Höhe erhöhen das Risiko signifikant.Begleitverletzungen sind in bis zu 80% der Fälle vorhanden und betreffen andere Wirbelsäulenabschnitte, Schädel-Hirn-Trauma und Extremitäten. Die Segmente C5–6 und C6–7 sind am häufigsten betroffen.Die AO Spine-Klassifikation für subaxiale HWS-Verletzungen, eingeführt 2015, berücksichtigt Facettenverletzungen und neurologischen Status. Diagnostisch ist die Canadian-C-Spine-Rule relevant, während die CT für die primäre HWS-Bildgebung bevorzugt wird.Therapieoptionen umfassen konservative Ansätze für nicht dislozierte Frakturen, während operative Eingriffe, ventral oder dorsal, bei instabilen Verletzungen erforderlich sind. Die Wahl der Therapie hängt von verschiedenen Faktoren ab, darunter die Art der Verletzung und der neurologische Status.Die Prognose nach HWS-Verletzungen variiert je nach Grad der neurologischen Beteiligung. Ohne Rückenmarkverletzung erzielen die meisten Patienten gute Ergebnisse, während Rückenmarkverletzungen die Lebensqualität negativ beeinflussen. Die Rückkehr in den Beruf gelingt in vielen Fällen, und radikuläre Läsionen heilen häufig symptomfrei aus. Relevante Nackenschmerzen sind jedoch in etwa 20% der Fälle nach 2,5 Jahren zu verzeichnen.

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“…2 Several studies have evaluated the use of F/E radiographs among blunt trauma patients, but few have addressed any long-term neurologic sequelae resulting from the F/E examination. [3][4][5][6][7][8][9][10][11][12][13] Therefore, this study evaluated the presence of neurologic sequelae among non-obtunded trauma patients who received F/E radiographs due to concern for a neck injury.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Long-Term Neurologic Sequelae Among Trauma Patients who Received Flexion-Extension Radiographs

Durler,

Lightwine,

Ablah

et al. 2024

kjm

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Introduction. This study evaluated the presence of neurologic sequelae among trauma patients after flexion-extension (F/E) radiographs. Methods. Authors of the study conducted a retrospective review of patients (age ≥ 14 years) with a Glasgow Coma Score of 15 who sustained a blunt traumatic injury and received F/E radiographs. Radiographic scans were defined as positive, negative, inconclusive, or incomplete. The neurologic status of each patient was assessed before and after the F/E radiographs, and at discharge and follow-up. Results. Of the 501 patients included in the analysis, 84.6% (n = 424) had negative F/E radiographs, and 3.2% (n = 16) had positive F/E radiographs. Ten percent (n = 51) of patients had incomplete F/E radiographs, and 2.0% (n = 10) were inconclusive due to the inability to rule out a ligamentous injury. Three patients (0.6%) had MRI-confirmed ligamentous injuries, all of which had initial incomplete F/E radiographs due to pain. No patient had a documented neurological deficit before or after the F/E exam. Three patients with an initial negative F/E radiograph returned to the clinic with symptoms of neurologic sequelae. Two of these patients had symptom resolution with no further issues at future follow-up appointments. The third patient was found to have chronic neurologic symptoms after further evaluation. Conclusions. The inclusion of F/E exams in cervical spine clearance protocols did not demonstrate any new long-term iatrogenic neurologic injuries. Consideration should be given to performing MRIs on patients with incomplete F/E radiographs that cannot rule out a ligamentous injury.

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Diagnostic accuracy of flexion‐extension radiography for the detection of ligamentous cervical spine injury following a normal cervical spine computed tomography

Abstract: FER does not contribute additional diagnostic accuracy for the detection of ligamentous injury to the cervical spine following a normal CT of the cervical spine. We recommend FER be removed from cervical spine clearance protocols.

Cited by 7 publications

References 25 publications

Feasibility and Safety of Cervical Kinematic Magnetic Resonance Imaging in Patients with Cervical Spinal Cord Injury without Fracture and Dislocation

Feasibility and Safety of Cervical Kinematic Magnetic Resonance Imaging in Patients with Cervical Spinal Cord Injury without Fracture and Dislocation

Verletzungen der subaxialen Halswirbelsäule

Evaluating the Long-Term Neurologic Sequelae Among Trauma Patients who Received Flexion-Extension Radiographs

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