Are soft tissue measurements on lateral cervical spine X-rays reliable in the assessment of traumatic injuries?

Patel, Mohammed Shakil; Grannum, S; Tariq, Ahmed; Qureshi, Assad; Watts, Ashlee E.; Gabbar, Omar Abdul

doi:10.1007/s00068-013-0302-6

Cited by 3 publications

(10 citation statements)

References 14 publications

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“…DeBehnke and Havel 22 employed comparable methodology in adults and found similar patterns but did not accept any point on the ROC curve as adequate. Patel et al 16 also demonstrated similar high specificities and low sensitivities in testing adults using the '7 mm at C2 and 2 cm at C7' rule.…”

Section: Discussionmentioning

confidence: 83%

“…1 Although soft tissue swelling on X-ray has been referred to as an aid in identifying injury, 1,2 published measurement methods and recommendations on what constitutes swelling vary, as does the diagnostic significance of said swelling. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] Measurements in millimetres (mm) may not be applicable across wide age ranges and an alternative is measurement as a ratio of vertebral body width. Some published normal values are based on primary evidence, but many statements regarding measurement norms are uncited, or citations do not correctly support the measurement.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of Soft tissue Projection in Injured NEcks (CSPINE) - Prevertebral soft tissue measurement in paediatric cervical spine trauma

et al. 2020

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Background: In paediatric trauma, measured increase in prevertebral soft tissue thickness on a lateral cervical spine (C-spine) X-ray is interpreted as swelling, raising suspicion of C-spine injury. Defining swelling in absolute measurements is cumbersome-children's sizes vary. Published recommendations are largely lacking in evidence. There may be potentially more consistent tools, for example, to measure soft tissue thickness as a ratio of vertebral body width. The aim of this study was to determine whether consistent, measurable prevertebral soft tissue to vertebral body width ratios exist for use as simple diagnostic tools in the assessment of swelling and injury in paediatric C-spine trauma. Patients and methods: C-spine trauma X-rays taken at a South African children's hospital were randomly sampled. Seventy-one unintubated X-rays from 85 controls were used to identify normal ratios. The authors measured vertebral bodies and soft tissue at each level, created all possible ratios, then chose the two least variable-one for the upper and one for the lower C-spine. Twenty cases aided in determining diagnostic accuracy for C-spine injury. Results: Mean soft tissue at the second cervical vertebral level (c2) was 38% of the seventh vertebra (C7) (95% confidence interval [CI]: 34-41.9%, standard error [SE]: 2.0%). Mean c6 soft tissue was 65.6% of C7 vertebra (95% CI: 61.9-69.3%, SE: 1.9%). In diagnosing C-spine injury, a receiver operating characteristic (ROC) curve calculation gave an empirical optimal cut-point of 53.9% and 74.4% respectively. Using practical cutoffs of 55% at c2 and 75% at c6 yielded specificities of 93.8% (95% CI: 84.8-98.3%) and 81.8% (95% CI: 70.4-90.2%), with negative predictive values of 90.9% (95% CI: 81.3-96.6%) and 91.5% (95% CI: 81.3-97.2%) respectively. Conclusion: Consistent and specific ratios exist in the upper and lower paediatric C-spine. Both ratios have poor sensitivities and positive predictive values and so are poor screening tools; however, a positive result can raise suspicion of C-spine injury in high-risk individuals. This can help to motivate for further investigations such as computer tomography (CT) or magnetic resonance imaging (MRI), which may not be easily accessible in under-resourced settings. However, further research is required to validate the diagnostic value of these ratios.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Correlation of Soft tissue Projection in Injured NEcks (CSPINE) - Prevertebral soft tissue measurement in paediatric cervical spine trauma

et al. 2020

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“…Previous studies performed in adults confirm the above conclusion. 23,[26][27][28] The reported adult sensitivities of PVST range from 5 to 82.5% due to differing methodology: variable PVST dimension standards, cervical spine levels, and combinations of levels measured. 17,23,24,[26][27][28] The standards reported for the upper limits of normal retropharyngeal PVST width in adults vary from 4 to 7 mm.…”

Section: Discussionmentioning

confidence: 99%

Prevertebral Soft Tissue Thickness of the Cervical Spine in Children: An Insensitive but Specific Aid in the Diagnosis of Occult Trauma

Karlin¹,

Jordan²,

Miller³

et al. 2022

Journal of Pediatric Orthopaedics

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Background: The purpose of this study was to investigate the sensitivity and specificity of current cervical prevertebral soft tissue swelling (PVST) values in a cohort of children with known cervical fractures or dislocations. Methods: Forty two children (average age 11.9, range 1.4 to 17.0 y) with documented cervical spine injury and 61 children (average age 11.9, range 0.5 to 17.9 y) with cervical pain but no injury were reviewed (January 2004 to December 2015). PVST was measured on lateral cervical radiographs at C2, C3, and C6. Patients were stratified by age (0 to 2 y, 3 to 6 y, 7 to 10 y, 11 to 15 y, and 16 y and above). The Wilcoxon rank sum test was used to compare PVST measurements at each spine level across injury and noninjury cohorts. Sensitivity and specificity were estimated to assess the ability of abnormal reference values to detect when a true injury was present. In addition, positive predictive value and negative predictive value were also estimated. Results: The majority of c-spine injuries (31/42; 76%) involved bony fracture and 57% (24/42) were treated with a collar or brace. Comparison of PVST measurement found no difference at C2 (P=0.07), C3 (P=0.07), or at C6 (P=0.99) across injury and non-injury cohorts. Sensitivity was poor at single-level measures for C2 (26%), C3 (31%), and C6 (24%), while specificity was relatively high (92%, 87%, and 79%, respectively). When an increased value at either C2 or C3 indicated injury, sensitivity increased to 36%, and when an increased measurement at just one of the 3 measured levels indicated injury, the sensitivity increased to 48%, while the specificity decreased to 72%. While retropharyngeal measures were more likely to detect injury than retrotracheal, C6 alone was increased in 5 of the 20 injury patients. Conclusions: PVST measurements exhibit poor sensitivity but good specificity as indicators for the diagnosis of occult cervical trauma in children. Negative values do not exclude injury; positive values suggest further evaluation. Levels of Evidence: Level III

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“…Anterior-posterior width of PVSTs has long been considered a valuable radiographic measurement for evaluating cervical spine trauma [117], [135]. As the most reliable indicator of this injury, an increase of this shadow or abnormal signal of PVSTs implies the probable oedema or haematoma in the PVSTs (such as the prevertebral fascia, buccopharyngeal fascia, the superior and middle pharyngeal constrictor muscles and the longitudinal esophageal muscle) as well as rupture of anterior longitudinal ligament, secondary to cervical trauma [113], [117], [136].…”

Section: Discussionmentioning

confidence: 99%

“…Specially two radiologists and two orthopedic surgeons jointly measured the prevertebral soft tissues (PVSTs) image according to the 'seven at two and two at seven' rule [113], [114], determined whether the patient had cervical stenosis based on the 'Pavlov ratio' [115], also determined if there was fracture, vertebral hyperosteogenesis or vertebral instability on the X-ray radiographic [116]. The MRI images were used to identify underlying lesions such as rupture of the anterior longitudinal ligament, ligamentum flavum hypertrophy, cervical disc herniation, cervical stenosis, and spinal cord injury [117], [118].…”

Section: Experimental Designsmentioning

confidence: 99%

Predicting Cervical Hyperextension Injury: A Covariance Guided Sine Cosine Support Vector Machine

et al. 2020

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This study proposes an effective intelligent predictive model for prediction of cervical hyperextension injury. The prediction model is constructed by combing an improved sine cosine algorithm (SCA) with support vector machines (SVM), which is named COSCA-SVM. The core of the developed model is the COSCA method that combines the opposition-based learning mechanism and covariance mechanism to boost and recover the exploratory competence of SCA. The proposed COSCA approach is utilized to optimize the two critical parameters of the SVM, and it is also employed to catch the optimal feature subset. Based on the optimal parameter combination and feature subset, COSCA-SVM is able to make self-directed prediction of cervical hyperextension injury. The proposed COSCA was compared with other well-known and effective methods using 23 benchmark problems. Simulation results verify that the proposed COSCA is significantly superior to studied methods in dealing with majority of benchmark problems. Meanwhile, the proposed COSCA-SVM is compared with six other machine learning approaches considering a reallife dataset. Results have shown that the proposed COSCA-SVM can achieve better classification routine and higher stability on all four indicators. Therefore, we can expect that COSCA-SVM can be a promising building block for predicting cervical hyperextension injury.

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Are soft tissue measurements on lateral cervical spine X-rays reliable in the assessment of traumatic injuries?

Cited by 3 publications

References 14 publications

Correlation of Soft tissue Projection in Injured NEcks (CSPINE) - Prevertebral soft tissue measurement in paediatric cervical spine trauma

Correlation of Soft tissue Projection in Injured NEcks (CSPINE) - Prevertebral soft tissue measurement in paediatric cervical spine trauma

Prevertebral Soft Tissue Thickness of the Cervical Spine in Children: An Insensitive but Specific Aid in the Diagnosis of Occult Trauma

Predicting Cervical Hyperextension Injury: A Covariance Guided Sine Cosine Support Vector Machine

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