Limitations of Cervical Radiography in the Evaluation of Acute Cervical Trauma

Woodring, John H.; Lee, Charles

doi:10.1097/00005373-199301000-00006

Cited by 228 publications

(85 citation statements)

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“…Fractures of the lateral mass and articular process were generally accepted as being produced by hyperextension or hyperextension combined with a rotational injury mechanism [12,23,24]. In our series, most injury types were classified into compressive-extension injuries followed by lateral flexion injuries, according to Allen's classification [4].…”

Section: Discussionmentioning

confidence: 90%

“…Several authors have pointed out a low accuracy in the initial diagnosis of lateral mass and articular process fractures [7,12,18,22,24]. These fractures are often involved in the lower cervical spine, and initial plain radiographs do not demonstrate the abnormality in many cases.…”

Section: Discussionmentioning

confidence: 99%

“…Levine et al reported that standard roentgenograms were effective in making the definitive diagnosis in only nine of 24 cases (38%) [18]. The use of CT or multidirectional tomography is recommended for better visualization of fracture and neural involvement [24,25].…”

Section: Discussionmentioning

confidence: 99%

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Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation

et al. 2004

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To clarify the injury pattern, initial spinal instability, degree of discoligamentous injuries in cervical lateral mass and facet joint fractures, we retrospectively analyzed radiological parameters and introduced a new classification for these injuries. Surgical treatment was performed with cervical pedicle screw fixation (CPS), and overall neurological and radiological outcome was evaluated with a minimum follow-up period of 2 years. Lateral mass fractures were divided into the following four subtypes: separation, comminution, split, and traumatic spondylolysis. The sagittal and frontal alignments were evaluated at both mainly injured and adjacent spinal segments on radiographs. The initial discoligamentous injuries were investigated on magnetic resonance imaging in terms of their frequencies, subtype of injuries, and involved spinal levels. Anterior translation of fractured vertebra was demonstrated in 77% of lateral mass fractures, while 24% of anterior translation was observed, even in cephaladadjacent vertebrae. On magnetic resonance imaging, signal changes in anterior longitudinal ligament (ALL) and intervertebral disc were demonstrated in 76% of caudal segments and 24% of cephalad segments adjacent to fractured vertebra of lateral mass fractures. The subtype analyses of lateral mass fractures demonstrated high rates of anterior translation in separation, split, and traumatic spondylolisthesis, as well as significant coronal malalignment in comminution and split types (p<0.05). Thirty-one patients underwent surgical treatments using a cervical pedicle screw fixation. The CPS provided the superior capability of deformity correction without pseudoarthrosis, as well as excellent neurological recovery. The average numbers of stabilized segments were minimized without serious complications. In separation, facet joint fracture, and fractures with mild lateral mass comminution, the single level posterior fixation can be considered. The significant unstable injuries of split and comminution type with coronal malalignment can be treated with exclusive two-level posterior stabilization with CPS. The initial evaluation of fracture subtypes helps to successfully minimize the stabilized spinal segment.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation

et al. 2004

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“…Eur Spine J (2010) 19 (Suppl 1):S8-S17 series of 216 consecutive patients with cervical injuries, using a combination of three X-ray views (anteroposterior, cross-table lateral, and open-mouth odontoid), 61% of all fractures were missed, 36% of (sub-) luxations were missed, and 23% of patients were falsely identified having normal spines, of whom half had in fact unstable cervical injuries [24]. Despite swimmers views, repeated attempts at open-mouth odontoid views, and other permutations of imaging, it is very often difficult to depict the entirety of the cervical spine to a satisfactory extent.…”

Section: Plain X-ray Filmsmentioning

confidence: 99%

“…At the time of injury, the average age of patients with traumatic spine lesions is 32 years and 55% of those injured are aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] years. Approximately, half of spinal injuries occur in the cervical spine, the other half involves the thoracic, lumbar, and sacral areas.…”

Section: Introductionmentioning

confidence: 99%

Trauma of the spine and spinal cord: imaging strategies

et al. 2009

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Traumatic injuries of the spine and spinal cord are common and potentially devastating lesions. We present a comprehensive overview of the classification of vertebral fractures, based on morphology (e.g., wedge, (bi)concave, or crush fractures) or on the mechanism of injury (flexion-compression, axial compression, flexiondistraction, or rotational fracture-dislocation lesions). The merits and limitations of different imaging techniques are discussed, including plain X-ray films, multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) for the detection. There is growing evidence that state-of-the-art imaging techniques provide answers to some of the key questions in the management of patients with spine and spinal cord trauma: is the fracture stable or unstable? Is the fracture recent or old? Is the fracture benign or malignant? In summary, we show that high-quality radiological investigations are essential in the diagnosis and management of patients with spinal trauma.

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