Mysterium Ligamentum alare Ruptur: Stellenwert der MRT-Diagnostik des Schleudertraumas - biomechanische, anatomische und klinische Studien

Bitterling, H.; Stäbler, Axel; Brückmann, H.

doi:10.1055/s-2007-963426

Cited by 21 publications

(4 citation statements)

References 24 publications

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“…None of the participants in the traumatic group had a diagnosis of alar ligament damage prior to high-field strength MRI. This would suggest that the diagnosis of an alar ligament lesion remains challenging [5,8,21,22], unless highly specialized MRI machines and protocols are followed.…”

Section: Discussionmentioning

confidence: 99%

“…The alar ligaments are important stabilizers of the cervical spine and may become damaged following trauma, hence require careful examination, particularly in patients who present with neck-related problems with a history of injury [1,2]. The gold standard for determining alar ligament damage is MRI [3,4] for which there is a growing body of evidence supporting its use [5][6][7]. New technical developments in MRI such as high-fidelity 3-T MRI [8] and improved protocols [9] provide better visualization of the alar ligaments than previous MRI methods [8,10].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

von¹,

Maloul²,

Hoffmann³

et al. 2018

Journal of Manual & Manipulative Therapy

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Introduction: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity. Method: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI. Results: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%. Discussion: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

von¹,

Maloul²,

Hoffmann³

et al. 2018

Journal of Manual & Manipulative Therapy

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“…concluded that MRI signal differences in the alar ligaments could not be differentiated from normal variants. [33]…”

Section: Discussionmentioning

confidence: 99%

Ability of magnetic resonance imaging to accurately determine alar ligament integrity in patients with atlanto-occipital injuries

Dyas

Niemeier

McGwin

et al. 2018

J Craniovert Jun Spine

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Objective:The objective of this study is to evaluate the the reliability of magnetic resonance imaging (MRI) in diagnosing alar ligament disruption in patients with potential atlanto-occipital dissociation (AOD).Materials and Methods:Three-blinded readers performed retrospective review on 6 patients with intra-operative confirmed atlanto-occipital dissocation in addition to a comparison cohort of patients with other cervical injuries that did not involve the atlanto-occipital articulation. Ligament integrity was graded from 1 to 3 as described by Krakenes et al. The right and left ligaments were assessed separately. Inter-observer agreement by patient, by group (AOD vs. non-AOD), and intra-observer agreement was calculated using weighted Cohen's kappa.Results:Interobserver agreement of alar ligament grade for individual patients ranged from slight to fair (κ = 0.05–0.30). Interobserver agreement of alar ligament grade for each group (AOD vs. non-AOD) ranged from fair to substantial (κ = 0.37–0.66). No statistically significant difference in categorical analysis of groups (AOD vs. non-AOD) and grade (0–1 vs. 2–3) was observed. Intraobserver agreement of individual patient's alar ligament grade ranged from moderate to substantial (κ = 0.50–0.62).Conclusion:The use of MRI to detect upper cervical ligament injuries in AOD is imperfect. Our results show inconsistent and unsatisfactory interobserver and intraobserver reliability in evaluation of alar ligament injuries. While MRI has immense potential for detection of ligamentous injury at the craniovertebral junction, standardized algorithms for its use and interpretation need to be developed.

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“…The validity of these tests in the detection of vertebral or carotid artery dissection is questionable, due to their poor sensitivity and specificity that has led some authors to suggest abandoning their routine use as screening tests. 6,19,20,55 The SharpPurser test has been shown to have good reliability and validity for the detection of sagittal plane instability (integrity of transverse ligament) of C1-2, when compared to the gold standard of lateralview cervical flexion stress radiographs, in individuals with rheumatoid arthritis. However, there is only minimal evidence on the reliability or validity of other physical examination procedures that are used to detect CCJ hypermobility in other planes of motion, such as the lateral shear test and palpation of C2 spinous process rotation with neck lateral flexion.…”

Section: Physical Examination Proceduresmentioning

confidence: 99%

Occult Hypermobility of the Craniocervical Junction: A Case Report and Review

Mathers¹,

Schneider²,

Timko³

2011

J Orthop Sports Phys Ther

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Mysterium Ligamentum alare Ruptur: Stellenwert der MRT-Diagnostik des Schleudertraumas - biomechanische, anatomische und klinische Studien

Abstract: Biomechanical studies give no evidence of alar ligament involvement in whiplash disease. Using MRI, signal alterations of alar ligaments can hardly be differentiated from common normal variants. Functional MRI provides no diagnostic yield.

Cited by 21 publications

References 24 publications

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

Ability of magnetic resonance imaging to accurately determine alar ligament integrity in patients with atlanto-occipital injuries

Occult Hypermobility of the Craniocervical Junction: A Case Report and Review

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