Is Computed Tomography of Nonvisualized C7-T1 Cost-Effective?

Tan, Elizabeth; Schweitzer, Mark E.; Vaccaro, Alexander; Spetell, Claire

doi:10.1097/00002517-199912000-00004

Cited by 26 publications

(6 citation statements)

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“…1,3,4,6,9,10,21,23,24,33,36,64,67,70,75 New technology even enables us to measure the degree of canal compromise and the extent of spinal cord compression. 29,31,43,55 (Figs.…”

Section: Imaging Studiesmentioning

confidence: 99%

Hyperextension cervical spine injuries and traumatic central cord syndrome

Aarabi¹,

Koltz²,

Ibrahimi³

2008

FOC

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Traumatic central cord syndrome (TCCS), regardless of its biomechanics, is the most frequently encountered incomplete spinal cord injury. Patients with TCCS present with disproportionate weakness of the upper extremities, and variable sensory loss and bladder dysfunction. Fractures and/or subluxations, forced hyperextension, and herniated nucleus pulposus are the main pathogenetic mechanisms of TCCS. Nearly 50% of patients with TCCS suffer from congenital or degenerative spinal stenosis and sustained their injuries during hyperextension as originally described by Schneider in 1954. Immunohistochemical and imaging studies indicate mild to moderate insult to axons and their ensheathing myelin in the lateral funiculi culminating in cytoskeletal injury and impaired conduction. More than one-half of these patients enjoy spontaneous recovery of motor weakness; however, as time goes on, lack of manual dexterity, neuropathic pain, spasticity, bladder dysfunction, and imbalance of gait render their activities of daily living nearly impossible. Based on the current level of evidence, there is no clear indication of the timing of decompression for relief of sustained spinal cord compression in hyperextension injuries. Future research, taking advantage of validated digital imaging data such as maximum canal compromise, maximum spinal cord compression, and lesion length on the CT and MR images, as well as more sensitive measures of bladder and hand function, spasticity, and neuropathic pain may help tailor surgery for a specific group of these patients.

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“…1,3,4,6,9,10,21,23,24,33,36,64,67,70,75 New technology even enables us to measure the degree of canal compromise and the extent of spinal cord compression. 29,31,43,55 (Figs.…”

Section: Imaging Studiesmentioning

confidence: 99%

Hyperextension cervical spine injuries and traumatic central cord syndrome

Aarabi¹,

Koltz²,

Ibrahimi³

2008

FOC

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“…Using published sensitivities for fracture identification for plain CSR and CCT, the authors concluded that 'CT is the preferred cervical screening modality in trauma patients at high and moderate risk for cervical spine fracture.' 22 That same year, Tan et al 11 published a costeffectiveness study looking at the use of CT to image C7 to T1 when not seen on plain radiographs. In 360 patients that required CT of C7 to T1, 11 fractures were identified.…”

Section: Evaluation Of the Cervical Spine After Blunt Traumamentioning

confidence: 99%

The Inefficiency of Plain Radiography to Evaluate the Cervical Spine After Blunt Trauma

Gale

Gracias

Reilly

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

114

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Plain CSR are inadequate to fully evaluate the cervical spine after blunt trauma, and supplemental CT is commonly required. Complete cervical spine CT is available, efficient, and accurate. Our findings support a growing body of literature that suggests that this modality should be used for blunt trauma patients who require radiographic evaluation of the cervical spine. Plain cervical spine radiographs need not be obtained. The EAST guidelines for cervical spine evaluation after blunt trauma should be updated to reflect this evolving practice pattern.

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“… 2 , 3 , 51 , 53 One possible explanation for the delayed diagnosis of cervical fractures might be the fact that minor trauma with only moderate pain is combined with insufficient radiodiagnostic examinations, in which osteoporosis and fractures in the cervicothoracic junction may be overlooked. 54 In addition, the physiological anatomy of the spine is sometimes substantially altered in patients with ASD, so that even with advanced imaging techniques it can still be challenging to identify the fractured levels. 55…”

Section: Delayed Diagnosis Of Cervical Fractures In Asd ( Tmentioning

confidence: 99%

“… 2 , 57 , 58 Due to the thin fracture lines, high-resolution multislice CT imaging is preferable as one of the most reliable tools for identifying the fractured levels. 54 , 59 – 61 Since the risk of concomitant spinal cord injury in patients with AS is 10 times higher than in the healthy population, additional MRI scans are strongly recommended and should be available for all patients. 5 , 22 , 43 , 62 , 63 Concomitant epidural hematomas, with bleeding from ruptured epidural veins or cancellous bone due to displacement of unstable fractures, can be adequately visualized or excluded using an MRI scan.…”

Section: Delayed Diagnosis Of Cervical Fractures In Asd ( Tmentioning

confidence: 99%

Analysis of the Literature on Cervical Spine Fractures in Ankylosing Spinal Disorders

Hartmann

Tschugg

Wipplinger

et al. 2017

Global Spine Journal

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Study Design:Narrative literature review.Objective:The numbers of low-energy cervical fractures seen in patients suffering from ankylosing spondylitis (also known as Bechterew disease) or diffuse idiopathic skeletal hyperostosis (also known as Forestier disease) have greatly increased over recent decades. These fractures tend to be particularly overlooked, leading to delayed diagnosis and secondary neurological deterioration. The aim of the present evaluation was to summarize current knowledge on cervical fractures in patients with ankylosing spinal disorders (ASDs).Methods:The literature was analyzed through an extensive PubMed search focusing on cervical fractures, especially with delayed diagnosis.Results:In ASDs, it was mainly the cervical spine that was found to be affected by fractures. Fifty percent of ASD patients had neurological deficits at admission, with a high probability of secondary deterioration due to an initially missed diagnosis. Multislice high-resolution imaging techniques should be the radiological standard of care if a vertebral fracture is suspected. Nevertheless, many of these spinal fractures are overlooked, leading to feared secondary deterioration of existing unstable fractures. Long posterior instrumentations were found to be the treatment of choice, followed by anterior and combined anterior-posterior instrumentations.Conclusions:Delayed diagnosis of cervical fractures in ASDs contributes to initially misinterpreted clinical symptoms, inadequate imaging techniques, and a lack of knowledge about this disease entity due to its peculiarities. Thorough assessment of the patients’ neurological morbidity at admission might reduce the occurrence of the associated fractures. The biomechanical behavior of ASD fractures is completely different from that of non-ASD fractures, so that the treatment strategy for these patients should be at least surgical, in combination with long dorsal instrumentations or combined anterior-posterior approaches.

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Is Computed Tomography of Nonvisualized C7-T1 Cost-Effective?

Cited by 26 publications

References 0 publications

Hyperextension cervical spine injuries and traumatic central cord syndrome

Hyperextension cervical spine injuries and traumatic central cord syndrome

The Inefficiency of Plain Radiography to Evaluate the Cervical Spine After Blunt Trauma

Analysis of the Literature on Cervical Spine Fractures in Ankylosing Spinal Disorders

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