Evaluation of the Intervertebral Disk Angle for the Assessment of Anterior Cervical Diskoligamentous Injury

Abstract

BACKGROUND AND PURPOSE:The anterior diskoligamentous complex is important for cervical spinal stability. Subjective widening of the disk space after trauma has been used to gauge disruption of the anterior diskoligamentous complex on CT scanning, but no quantitative CT measurements exist to evaluate injury. The purpose of our study was to evaluate if an increased intervertebral disk angle could serve as a more sensitive, reproducible indicator of disruption of the anterior diskoligamentous complex compared with subjective assessment.

Evaluation of subjective anterior disc space widening on trauma cervical spine CT as a potential sign of ligamentous injury

“…In the absence of a fracture identified on CT, the presence of subjective anterior disc space widening reported on a CT of the cervical spine performed in the setting of trauma is a poor predictor of injury to the anterior longitudinal ligament with a sensitivity of only 8.2% (95% CI 2.7–18.2%) and a positive predictive value of 10.2%. This is broadly consistent with the results from the only other study assessing subjective disc space widening by Alhilali and Fakhran 15 which demonstrated a sensitivity of 16.4% (95% CI 10.5–24.3%).…”

“…Given the inherently subjective nature of ADW, it may be that more experienced radiologists would have a higher threshold for reporting these signs on CT. Further research could be performed comparing the accuracy and interobserver reliability of these signs when assessed by experienced MSK or trauma subspeciality radiologists and assessing whether specific measured thresholds would yield better results, similar to the study by Alhilali and Fakhran. 15 Secondly, despite a relatively large sample size fulfilling the previously defined study criteria (n = 1305), the incidence of isolated ALL injury on MRI was small; thus, the 95% confidence interval for sensitivities of ADW was relatively wide. Furthermore, care needs to be taken when interpreting sensitivity, specificity and positive and negative predictive values of the subjective CT-ADW as these measures have been shown to vary with disease prevalence.…”

“…While all MRIs were reported (or consultant approved) by radiologists with MRI or neuro/MSK subspecialty training, CTs were reported (or consultant approved) by either subspecialty trained or general radiologists. Given the inherently subjective nature of ADW, it may be that more experienced radiologists would have a higher threshold for reporting these signs on CT. Further research could be performed comparing the accuracy and interobserver reliability of these signs when assessed by experienced MSK or trauma subspeciality radiologists and assessing whether specific measured thresholds would yield better results, similar to the study by Alhilali and Fakhran 15 …”

A Novel Radiological Scoring System for Anterior Longitudinal Ligament Injuries

“…The scoring system includes seven markers based on clinical experience and a review of a wide number of literatures, including TOPST, IDA, AFOA and so on. 12,19,[26][27][28][29][30] C3 prevertebral soft tissue shadow was utilized to represent C1-4 because it is less impacted by skull base shadow and easier to measure. C6 indicates C5-7 because the prevertebral soft tissue shadow of C6 is less easily impacted by laryngeal movement than C4 or C5.…”