Magnetic Resonance Imaging (MRI) in the Clearance of the Cervical Spine in Blunt Trauma: A Meta-Analysis

Muchow, Ryan D.; Resnick, Daniel K.; Abdel, Matthew P.; Munoz, Alejandro; Anderson, Paul A.

doi:10.1097/01.ta.0000238664.74117.ac

Cited by 118 publications

(68 citation statements)

References 32 publications

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“…58,65,67,85,90 Although a lower threshold for the use of advanced imaging would hypothetically result in the detection and possible prevention of a greater number of CSIs, these benefits must be weighed against the associated risks and considerable costs of performing such studies and the additional treatments initiated due to false-positive results. 18,19,41,77 Indeed, complications have been reported in 6-71% of critically ill patients during and after transport.…”

mentioning

confidence: 99%

Prevalence of cervical spinal injury in trauma

Milby

Halpern

Guo

et al. 2008

FOC

121

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Object Diagnosis of cervical spinal injury (CSI) is an essential aspect of the trauma evaluation. This task is especially difficult in patients who are not clinically able to be evaluated (unevaluable) because of distracting painful injuries, intoxication, or concomitant head injury. For this population, the appropriate use of advanced imaging techniques for cervical spinal clearance remains undetermined. This study was undertaken to estimate the prevalence of unstable CSI, particularly among patients in whom clinical evaluation is impossible or unreliable. Methods Estimates of the prevalence of CSI in populations consisting of all trauma patients, alert patients only, and clinically unevaluable patients only were determined by variance-weighted pooling of data from 65 publications (281,864 patients) that met criteria for review. Results The overall prevalence of CSI among all trauma patients was 3.7%. The prevalence of CSI in alert patients was 2.8%, whereas unevaluable patients were at increased risk of CSI with a prevalence of 7.7% (p = 0.007). Overall, 41.9% of all CSI cases were considered to exhibit instability. Conclusions Trauma patients who are clinically unevaluable have a higher prevalence of CSI than alert patients. Knowledge of the prevalence and risk of such injuries may help establish an evidence-based approach to the detection and management of clinically occult CSI.

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mentioning

confidence: 99%

Prevalence of cervical spinal injury in trauma

Milby

Halpern

Guo

et al. 2008

FOC

121

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“…Clearing the cervical spine following institutional protocol did not initially detect the severity of instability in 11 % of injuries in the present study. In light of its ability to detect ligamentous and soft tissue lesions and osseous edema, MRI is accepted as the most reliable imaging modality for discoligamentous injuries with a reported negative predictive value of up to 100 % [20][21][22][23], thus precluding unstable discoligamentous injuries [20,21,24]. The false-negative rate for secondary MRI to detect discoligamentous injuries where the initial CT scan was negative was reported to be up to 25 % [8-10, 24, 25].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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“…Muchow ve ark. nın [17] yakın zamanda yaptıkları meta-analizde servikal travmalı hastaların değerlendirilmesinde MR'nin duyarlılığı %97.2, seçiciliği %98.5, NPV'si %100, pozitif tahmin değeri (PPV-positive predictive value) %94.2 olarak saptanmış ve radyografileri ve BT'si negatif olan hastaların %20.9'unda MR görüntüle-menin anormal olduğuna dikkat çekilmiştir.…”

Section: Servikal Omurgaunclassified

Radiologic examinations in orthopedic emergencies

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2013

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Magnetic Resonance Imaging (MRI) in the Clearance of the Cervical Spine in Blunt Trauma: A Meta-Analysis

Cited by 118 publications

References 32 publications

Prevalence of cervical spinal injury in trauma

Prevalence of cervical spinal injury in trauma

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

Radiologic examinations in orthopedic emergencies

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