Radiographic Evaluation of Cervical Spine Injuries

Clark, Charles R.; Igram, Cassim; el-Khoury, G Y; Ehara, Shigeru

doi:10.1097/00007632-198807000-00006

Cited by 76 publications

(17 citation statements)

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“…Moreover, fractures of the axis' odontoid basis-classified as Anderson and D'Alonzo type II fractures-represent the most frequent type of dens fractures with about 66% [3,9,18]. Odontoid fractures occur at all ages with a bimodal distribution.…”

Section: Introductionmentioning

confidence: 99%

Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases

et al. 2005

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IntroductionFractures of the odontoid process of the second cervical vertebra comprise 7-13 % of all cervical spine fractures [22]. Moreover, fractures of the axis' odontoid basis-classified as Anderson and D'Alonzo type II fractures-represent the most frequent type of dens fractures with about 66% [3,9,18]. Odontoid fractures occur at all ages with a bimodal distribution. In the younger group they are often secondary to high-energy trauma as motor vehicle accidents. The second peak in the incidence of odontoid fractures is in the elderly, where they appear as a result from low-energy injuries, such as falls from standing height [4,12,13,19]. Abstract During skeletal development the two ossification centers of the odontoid process are separated from the corpus of the axis by a subdental synchondrosis. This synchondrosis is thought to close and disappear spontaneously in adolescence although this has never been studied in detail. The basis of the dens is of clinical relevance as type II dens fractures are located here. To characterize the morphological architecture of the axis with particular attention to the subdental synchondrosis, the complete axis was harvested from thirty age-matched and gender-matched patients of the three different age groups at autopsy. The subdental synchondrosis and the bone structure of the dens, the basis of the dens and the body of C2 were analyzed by radiography, histology and quantitative histomorphometry. At the macroscopic level the persistency of the subdental synchondrosis in the adult cervical spine was detected in 87% (26 of 30) of the specimens. Histomorphometry revealed a residual disc blastema with an average size of 25.8% of the sagittal depth of the basis of the dens at this level. Bony integration of the synchondrosis was poor throughout all ages. Histologically a cartilaginous matrix composition of the subdental synchondrosis persisted throughout all groups. The trabecular microarchitecture demonstrated a significant reduction of bone volume and trabecular number as well as an increased trabecular separation within the basis of the dens as compared to the corpus or the dens of C2. This histomorphometric data regarding a poor integration of the synchondrosis into the trabecular network and the reduced bone mass within the basis of the dens might offer a previously underestimated explanation for the occurrence of type II dens fractures and their association with pseudoarthrosis, respectively. Matthias Gebauer

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Section: Introductionmentioning

confidence: 99%

Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases

et al. 2005

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“…Alternatively, the cervicothoracic junction can be evaluated by conventional supine oblique radiographs in combination with a frontal view of this region to "clear" the lower cervical spine, particularly in overweight individuals or those with heavy shoulder musculature. Conventional and complex motion tomography has also been reported as useful for sagittally oriented cervical spine fractures, particularly injuries involving the facets [9,10]. Pillar views are advantageous for occult fracture of lateral masses.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

et al. 1994

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Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in "clearing" the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had "clay-shoveler" fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury.

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“…The most common reason cited for missed injuries is an inadequate radiographic examination 8. Characteristic injury patterns which are commonly missed include odontoid, teardrop, facet and hangman's fractures 9. Despite these common patterns, it has been recognized that even in the absence of fractures, clinically significant instability can exist.…”

Section: Epidemiologymentioning

confidence: 99%

Cervical spine trauma

Torretti

Sengupta

2007

Indian J Orthop

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Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries; elucidate associated pathology; classify injuries; and predict instability, treatment and outcomes. The unique anatomy of each region of the cervical spine demands a review of each segment individually. This article examines both upper cervical spine injuries, as well as subaxial spine trauma. The purpose of this article is to provide a review of the broad topic of cervical spine trauma with reference to the classic literature, as well as to summarize all recently available literature on each topic.Identification of References for Inclusion:A Pubmed and Ovid search was performed for each topic in the review to identify recently published articles relevant to the review. In addition prior reviews and classic references were evaluated individually for inclusion of classic papers, classifications and previously unidentified references.

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Radiographic Evaluation of Cervical Spine Injuries

Cited by 76 publications

References 0 publications

Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases

Subdental synchondrosis and anatomy of the axis in aging: a histomorphometric study on 30 autopsy cases

Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

Cervical spine trauma

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