Clinical Relevance of Magnetic Resonance Imaging in Cervical Spine Clearance

Resnick, Shelby; Inaba, Kenji; Karamanos, Efstathios; Pham, Martin H.; Byerly, Saskya; Talving, Peep; Reddy, Sravanthi; Linnebur, Megan; Δημητριάδης, Δημήτριος

doi:10.1001/jamasurg.2014.867

Cited by 36 publications

(24 citation statements)

References 35 publications

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“…The primary brain MRI outcome was total brain volume (TBV), which was chosen based on evidence that diabetes can lead to mixed vascular and neurodegenerative changes [11,12] and changes in TBV over time [13], and can affect the relationship between TBV and cognitive function. The secondary brain MRI outcome was abnormal white matter volume (AWM), which is indicative of diffuse and focal ischaemic, demyelinating and inflammatory processes that can lead to small vessel disease, and is associated with diabetes and impaired cognition [14,15].…”

Section: Introductionmentioning

confidence: 99%

ACCORDION MIND: results of the observational extension of the ACCORD MIND randomised trial

et al. 2016

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Aims/hypothesis The Memory in Diabetes (MIND) substudy of the ACCORD study, a double 2×2 factorial parallel-group randomised clinical trial, tested whether intensive compared with standard management of hyperglycaemia, BP or lipid levels reduced cognitive decline and brain atrophy in 2977 people with type 2 diabetes. We describe the results of the observational extension study, ACCORDION MIND (ClinicalTrials.gov registration no. NCT00182910), which aimed to measure the long-term effects of the three ACCORD interventions on cognitive and brain structure outcomes approximately 4 years after the trial ended. Methods Participants (mean diabetes duration 10 years; mean age 62 years at baseline) received a fourth cognitive assessment and a third brain MRI, targeted at 80 months post-randomisation. Primary outcomes were performance on the Digit Symbol Substitution Test (DSST) and total brain volume (TBV). The contrast of primary interest compared glycaemic intervention groups at the ACCORDION visit; secondary contrasts were the BP and lipid interventions. Results Of the surviving ACCORD participants eligible for ACCORDION MIND, 1328 (68%) were re-examined at the ACCORDION follow-up visit, approximately 47 months after the intensive glycaemia intervention was stopped. The significant differences in therapeutic targets for each of the three interventions (glycaemic, BP and lipid) were not sustained. We found no significant difference in 80 month mean change from baseline in DSST scores or in TBV between the glycaemic intervention groups, or the BP and lipid interventions. Sensitivity analyses of the sites with ≥70% participation at 80 months revealed consistent results. Conclusions/interpretation The ACCORD interventions did not result in long-term beneficial or adverse effects on cognitive or brain MRI outcomes at approximately 80 months follow-up. Loss of separation in therapeutic targets between treatment arms and loss to follow-up may have contributed to the lack of detectable long-term effects.

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Section: Introductionmentioning

confidence: 99%

ACCORDION MIND: results of the observational extension of the ACCORD MIND randomised trial

et al. 2016

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“…Unfortunately, there is even less data supporting the accuracy of CT screening in this patient population. In a contemporary prospective observational study of 830 patients, for those with tenderness or a neurologic deficit, the sensitivity was again found to be 100% for clinically significant injuries(24). …”

Section: Discussionmentioning

confidence: 99%

“…A power analysis was performed assuming a conservative estimated incidence of clinically significant C-spine injury of 2% derived from the largest prospective study cohort to date(24). The sample size needed to achieve statistical significance at the 5% level, 2-tailed, with β value of 0.20 was 5,350 to detect 107 patients with a clinically significant injury.…”

Section: Methodsmentioning

confidence: 99%

“…For patients who require imaging because of persistent midline tenderness or neurologic deficits and have a negative CT, less data is available. In a recent prospective, single center observational study, 830 patients with tenderness or focal neurologic deficit were evaluated with CT, which was found to have a sensitivity and specificity of 100% for clinically significant injuries(24). …”

Section: Introductionmentioning

confidence: 99%

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Cervical spinal clearance

Inaba

Byerly

Bush

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background For blunt trauma patients who have failed the NEXUS low-risk criteria, the adequacy of CT as the definitive imaging modality for clearance remains controversial. The purpose of this study was to prospectively evaluate the accuracy of CT for the detection of clinically significant C-spine injury. Methods Prospective multicenter observational study (09/2013-03/2015), at 18 North American Trauma Centers. All adult (≥18yo) blunt trauma patients underwent a structured clinical examination. NEXUS failures underwent a CT of the C-spine with clinical follow up to discharge. The primary outcome measure was sensitivity and specificity of CT for clinically significant injuries requiring surgical stabilization, halo or cervical-thoracic orthotic (CTO) placement using the gold standard of final diagnosis at the time of discharge, incorporating all imaging and operative findings. Results 10,765 patients met inclusion criteria, 489 (4.5%) were excluded (previous spinal instrumentation or outside hospital transfer). 10,276 patients [4,660 (45.3%) unevaluable/distracting injuries, 5,040 (49.0%) midline C-spine tenderness, 576 (5.6%) neurologic symptoms] were prospectively enrolled: mean age 48.1yo (range 18-110), SBP 138 (SD 26), median GCS 15 (IQR 14,15), ISS 9 (IQR 4,16). Overall, 198 (1.9%) had a clinically significant C-spine injury requiring surgery [153 (1.5%)] or halo [25 (0.2%)] or CTO [20 (0.2%)]. The sensitivity and specificity for clinically significant injury was 98.5% and 91.0% with a NPV of 99.97%. There were 3 (0.03%) false negative CT scans that missed a clinically significant injury, all had a focal neurologic abnormality on their index clinical examination consistent with central cord syndrome and 2 of 3 had severe degenerative disease. Conclusions For patients requiring acute imaging for their C-spine after blunt trauma, CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. For patients with an abnormal neurologic exam as the trigger for imaging, there is a small but clinically significant incidence of a missed injury and further imaging with MRI is warranted. Level of Evidence Level II, Diagnostic Tests or Criteria

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“…[15][16][17][18] What follows is a synthesis of recent literature on manual therapy to the cervical spine for 4 common classifications of neck pain. Emphasis has been placed on summarizing high-quality randomized clinical trials, systematic reviews with a narrative synthesis or meta-analysis, and clinical practice guidelines.…”

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confidence: 99%

Cervical Spine Manual Therapy for Aging and Older Adults

Tudini

Chui

Grimes

et al. 2016

Topics in Geriatric Rehabilitation

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Neck pain is a common problem in aging and older adults. This narrative review synthesizes recent literature on manual therapy to the cervical spine and adjacent regions. Emphasis has been placed on summarizing high-quality randomized clinical trials, systematic reviews with a narrative synthesis or meta-analysis, and clinical practice guidelines. The synthesis suggests that although there is limited high-quality evidence, a multimodal approach including manual therapy and exercise seems safe and effective, especially in the short term, for improving outcomes in aging and older adults with neck pain. The results for cervicogenic dizziness and headache were too varied to arrive at a firm conclusion. Additional research using consistent outcome measures is needed to establish the optimal manual therapy techniques and parameters for these common cervical conditions. , PT, DPT, MS, OCS, ATC 20% of individuals 70 years of age and older experience neck pain at least one time per month. 11 Within this population, neck pain is associated with other health complaints and poorer self-rated health. 12 Physical therapy is one of the first treatment options for patients with mechanical, insidious neck pain, often with manual therapy as the preferred approach. 13 This is especially true in the elderly population where pain medication must be used cautiously because of the risk of drug interactions and associated comorbidities. 14 For this review, neck pain is classified into 4 categories: chronic nonspecific neck pain, cervical radiculopathy, cervicogenic dizziness and headache, and acute and subacute neck pain including whiplash.Although beyond the scope of this article, there are several useful reviews on pathophysiology, imaging, and conservative and surgical management of cervical spine pathology. 15-18 What follows is a synthesis of recent literature on manual therapy to the cervical spine for 4 common classifications of neck pain. Emphasis has been placed on summarizing high-quality randomized clinical trials, systematic reviews with a narrative synthesis or meta-analysis, and clinical practice guidelines. CHRONIC NONSPECIFIC NECK PAINNonspecific neck pain is defined as cervical pain without pathogenic and/or pathognomonic signs and symptoms. 13 When serious pathology and specific diseases have been excluded, the anatomical source of symptoms is difficult to establish. 19 Thus, this type of pain has also been named cervical pain of unknown origin. 20 Other popular names include the cervical syndrome, which refers to a set of disorders caused by changes in the cervical spine and the soft tissue surrounding it, with pain as the predominant symptom, 21 or chronic mechanical neck pain. Chronic nonspecific neck pain is very common, affecting up to 46% to 54% of the population. 22 It is also described as a significant predictor of sickness absence. 23 SafetyAn analytical review of orthopedic manual therapy including manipulation, specifically to the cervical spine and in an older population, should be preceded by a discussion ...

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Clinical Relevance of Magnetic Resonance Imaging in Cervical Spine Clearance

Abstract: Computed tomography is effective in the detection of clinically significant CS injuries in adults deemed eligible for evaluation who had a neurologic deficit or CS pain. Magnetic resonance imaging does not provide any additional clinically relevant information.

Cited by 36 publications

References 35 publications

ACCORDION MIND: results of the observational extension of the ACCORD MIND randomised trial

ACCORDION MIND: results of the observational extension of the ACCORD MIND randomised trial

Cervical spinal clearance

Cervical Spine Manual Therapy for Aging and Older Adults

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