Emergency radiology: straightening of the cervical spine in MDCT after trauma—a sign of injury or normal variant?

Linsenmaier, Ulrich; Deák, Zsuzsanna; Krtakovska, Aina; Ruschi, Francesco; Kammer, Nora; Wirth, Stéfan; Reiser, Maximilian; Geyer, Lucas L.

doi:10.1259/bjr.20150996

Cited by 8 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data from Marshall [42], for example, provide evidence that patients involved in an MVC injury have a 10 • mean reduction in the C1-C7 Cobb angle of cervical lordosis compared to a control group. Complicating matters is that conflicting results have been reported whereby the relationship of altered cervical curvatures to prognostic outcomes following exposure to an MVC (both short-and long-term) has been refuted [43][44][45][46]. Still, according to our review, the majority of the literature indicates that patients with injuries resulting from an MVC have a significantly greater frequency and magnitude of altered cervical curve configurations [15][16][17][18][19][20][21]23,42].…”

Section: Loss Of Lordosis In Mvc Populationsmentioning

confidence: 86%

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure

Haas,

Oakley,

Ferrantelli

et al. 2024

Diagnostics

View full text Add to dashboard Cite

Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to an MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. Methods: Three spine clinic records were reviewed over a 2-year period, looking for patients where both an initial lateral cervical X-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards, an additional exam and radiographic analysis were obtained. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2–C7), Chamberlain’s line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. Results: There were 15 males and 26 females with an age range of 8–65 years. Most participants were drivers (28) involved in rear-end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p < 0.001. The NDI was available on 24/41 (58.5%) patients and increased after the MVC from 15.7% to 32.8%, p < 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in the mean radius of curvature (265.5 vs. 555.5, p < 0.001) and an approximate 8° reduction of lordosis from C2–C7; p < 0.001. The mid-cervical spine (C3–C5) showed the greatest curve reduction with an averaged localized mild kyphosis at these levels. Four participants (10%) developed segmental translations that were just below the threshold of instability, segmental translations < 3.5 mm. Conclusions: The post-exposure MVC cervical curvature was characterized by an increase in radius of curvature, an approximate 8° reduction in C2–C7 lordosis, a mild kyphosis of the mid-cervical spine, and a slight increase in anterior translation of C2–C7 sagittal balance. The modelling result indicates that the post-MVC cervical sagittal alignment approximates a second-order buckling alignment, indicating a significant alteration in curve geometry. Future biomechanics experiments and clinical investigations are needed to confirm these findings.

show abstract

Section: Loss Of Lordosis In Mvc Populationsmentioning

confidence: 86%

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure

Haas,

Oakley,

Ferrantelli

et al. 2024

Diagnostics

View full text Add to dashboard Cite

show abstract

“…Data from Marshall and Tuchin [39], for example, provides evidence that patients involved in a MVC injury have a 10° mean reduction in the C1-C7 Cobb angle of cervical lordosis compared to a control group. Complicating matters is that conflicting results have been reported whereby the relationship of altered cervical curvatures to prognostic outcomes following exposure to an MVC (both short and long-term) has been refuted [40][41][42][43]. Still, according to our review, the majority of the literature indicates that patients with injuries resulting from an MVC have a significantly greater frequency and magnitude of altered cervical curve configurations [15][16][17][18][19][20][21]23,39].…”

Section: Loss Of Lordosis In Mvc Populationsmentioning

confidence: 86%

Abnormal Static Sagittal Cervical Curvatures Following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after Collision with Clinical Implications

Haas,

Oakley,

Ferrantelli

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to a MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. Methods: Three spine clinic records were reviewed, over a 2-year period, looking for patients where both an initial lateral cervical x-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards an additional exam and radiographic analysis were required. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain’s line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. Results: There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p &lt; 0.001. The NDI was available on 24 /41 (58.5%) patients and was found to increase following exposure to the MVC: 15.7% to 32.8%, p &lt; 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in radius of curvature and an approximate 8° reduction of lordosis from C2-C7; p &lt; 0.001. The mid cervical spine (C3-C5) showed the greatest curve reduction with localized mild kyphosis at these levels on average. Several participants developed segmental translations that approached the instability value of translation &gt; 3.5mm. Conclusions: Abnormalities of cervical lordosis occurred following exposure to a MVC. The average loss of cervical curvature was 8° from C2-C7, with mild flexion of the mid cervical segments. Snap through type or dynamic buckling during the MVC may explain our findings. The primary contribution of this study to the motor vehicle collision literature is that altered cervical lordosis may result from MVC exposures and the consequences of an altered cervical alignment, in turn, may lead to future pain, disability and decreased health-related quality of life.

show abstract

“…In addition, physical or medical constraints may prevent patients from being in an upright position. Second, retrospective analysis using supine MRI or CT images may be the only option [ 6 , 7 , 8 ]. Other than these situations, a clinician should at least keep in mind that upright radiography cannot be completely replaced by supine MRI, and that the assessment of cervical alignment based on MRI measurements may be inaccurate.…”

Section: Discussionmentioning

confidence: 99%

“…Although radiography with the patient in an upright position is considered the standard method for assessing sagittal cervical alignment [ 5 ], cervical alignment is frequently determined, or reported, based on magnetic resonance imaging (MRI) or computed tomography (CT), performed on subjects in a supine position [ 6 , 7 , 8 ]. However, the difference in the patient positioning and the use of a head stabilizer during MRI scanning may affect cervical alignment.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Magnetic Resonance Imaging for Sagittal Cervical Spine Alignment: A Retrospective Cohort Study

Noh

Lee

et al. 2021

IJERPH

View full text Add to dashboard Cite

(1) Background: Although radiography performed on the subject in an upright position is considered the standard method for assessing sagittal cervical alignment, it is frequently determined, or reported, based on MRI performed on the subject in a supine position. (2) Methods: Cervical alignment observed in both imaging modalities was assessed using four methods: the C2-7 Cobb angle, the absolute rotation angle (ARA), Borden’s method, and the sagittal vertical axis (SVA). Cervical alignment was determined (lordosis, kyphosis, and straight) based on radiography. Then, the diagnostic cut-off values for the MRI images and their corresponding diagnostic accuracies were assessed. (3) Results: The analysis included 142 outpatients. The determined diagnostic cut-off values for lordosis, using three measurements (Cobb angle, ARA, and Borden’s method), were −8.5°, −12.5°, and 3.5 mm, respectively, and the cut-off values for kyphosis were −4.5°, 0.5°, and −1.5 mm, respectively. The cut-off value for SVA > 40 mm was 19.5 mm. The Cobb angle, ARA, and Borden’s method, on MRI, showed high negative predictive values for determining kyphosis. The SVA on MRI measurements also showed high negative predictive values for determining >40 mm. (4) Conclusions: MRI measurements may be predictive of cervical alignment, especially for the exclusion of kyphosis and SVA > 40 mm. However, caution is needed in the other determinations using MRI, as their accuracies are limited.

show abstract

Emergency radiology: straightening of the cervical spine in MDCT after trauma—a sign of injury or normal variant?

Abstract: Straightening of the C-spine alignment in MDCT alone is not a definitive sign of injury. Straightening of the C-spine alignment is related to neck positioning and active patient control. CCI has a straightening effect on the cervical alignment.

Cited by 8 publications

References 28 publications

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure

Abnormal Static Sagittal Cervical Curvatures Following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after Collision with Clinical Implications

Diagnostic Accuracy of Magnetic Resonance Imaging for Sagittal Cervical Spine Alignment: A Retrospective Cohort Study

Contact Info

Product

Resources

About