MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

Raniga, Sameer; Menon, K. Venugopal; Muzahmi, Khamis Salim Al; Butt, Sajid

doi:10.1007/s13244-014-0311-y

Cited by 42 publications

(24 citation statements)

References 35 publications

(46 reference statements)

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“…Images were analyzed using a DICOM System, part of the PACS (picture archiving and communication system) Aurora 3 (version 1.5.5, Pixeon Medical System). 13,17,21 We excluded patients with incomplete clinical and radiological data.…”

Section: Methodsmentioning

confidence: 99%

“…3,4,6,7 While many studies suggested that the SLIC is reliable and safe, the morphological characterization of injuries was limited and unspecific. [10][11][12][13][14][15][16] In this context, in 2015, Vaccaro et al proposed a new classification for SCST based on CT evaluation and morphology, adopted by AOSpine, in an attempt to improve the morphological classification (Table 1). 3,[10][11][12][13][14][15][16] Given the importance of an accurate classification system to standardize treatment and compare outcomes, evaluation of the reliability and safety of this new morphological classification system is necessary.…”

mentioning

confidence: 99%

“…[10][11][12][13][14][15][16] In this context, in 2015, Vaccaro et al proposed a new classification for SCST based on CT evaluation and morphology, adopted by AOSpine, in an attempt to improve the morphological classification (Table 1). 3,[10][11][12][13][14][15][16] Given the importance of an accurate classification system to standardize treatment and compare outcomes, evaluation of the reliability and safety of this new morphological classification system is necessary. 20 In this paper, we evaluate the reliability of the new AOSpine classification system and the correlation of the new system with treatment for patients with subaxial cervical spine trauma.…”

mentioning

confidence: 99%

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Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

Silva

Sabba

Lira

et al. 2016

SPI

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OBJECTIVE The authors evaluated a new classification for subaxial cervical spine trauma (SCST) recently proposed by the AOSpine group based on morphological criteria obtained using CT imaging. METHODS Patients with SCST treated at the authors’ institution according to the Subaxial Cervical Spine Injury Classification system were included. Five different blinded researchers classified patients’ injuries according to the new AOSpine system using CT imaging at 2 different times (4-week interval between each assessment). Reliability was assessed using the kappa index (κ), while validity was inferred by comparing the classification obtained with the treatment performed. RESULTS Fifty-one patients were included: 31 underwent surgical treatment, and 20 were managed nonsurgically. Intraobserver agreement for subgroups ranged from 0.61 to 0.93, and interobserver agreement was 0.51 (first assessment) and 0.6 (second assessment). Intraobserver agreement for groups ranged from 0.66 to 0.95, and interobserver agreement was 0.52 (first assessment) and 0.63 (second assessment). The kappa index in all evaluations was 0.67 for Type A, 0.08 for Type B, and 0.68 for Type C injuries, and for the facet modifier it was 0.33 (F1), 0.4 (F2), 0.56 (F3), and 0.75 (F4). Complete agreement for all components was attained in 25 cases (49%) (19 Type A and 6 Type C), and for subgroups it was attained in 22 cases (43.1%) (16 Type A0 and 6 Type C). Type A0 injuries were treated conservatively or surgically according to their neurological status and ligamentous status. Type C injuries were treated surgically in almost all cases, except one. CONCLUSIONS While the general reliability of the newer AOSpine system for SCST was acceptable for group classification, significant limitations were identified for subgroups. Type B injuries were rarely diagnosed, and only mild (Type A0) and extreme severe (Type C) injuries had a high rate of interobserver agreement. Facet modifiers and intermediate injury patterns require better descriptions to improve their low agreement in cases of SCST.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

Silva

Sabba

Lira

et al. 2016

SPI

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“…Each category is analyzed individually and scored. A score less than or equal to three indicates conservative management while a score greater than five suggests surgical intervention [6][7][8]. Early surgery is thought to benefit patients with unstable fractures but there is no consensus on the timing or type of surgery.…”

Section: Introductionmentioning

confidence: 99%

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

Alexander

Dowlati

McGowan

et al. 2019

Spinal Cord Ser Cases

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Introduction Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions. Case presentation We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries. Discussion Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.

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“…For consideration of blunt trauma affecting the sub-axial cervical spine (i.e. trauma of the cervical spine below the craniocervical junction), the reader is directed to other such dedicated reviews [1]. …”

Section: Introductionmentioning

confidence: 99%

The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma

2016

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Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. The radiologist has a significant part to play in the appropriate management of patients who have suffered injury to this vital junction between the cranium and the spine. Knowledge of the embryology and normal anatomy as well as normal variant appearances avoids inappropriate investigations in these trauma patients. Osseous injury can be subtle while representing important radiological red flags for significant underlying ligamentous injury. An understanding of bony and ligamentous injury patterns can also give some idea of the biomechanics and degree of force required to inflict such trauma. This will assist greatly in predicting risk for other critical injuries related to vital neighbouring structures such as vasculature, brain stem, cranial nerves and spinal cord. The embryology and anatomy of the craniocervical junction will be outlined in this review and the relevant osseous and ligamentous injuries which can arise as a result of blunt trauma to this site described together. Appropriate secondary radiological imaging considerations related to potential complications of such trauma will also be discussed.Teaching points• The craniocervical junction is a distinct osseo-ligamentous entity with specific functional demands.• Understanding the embryology of the craniocervical junction may prevent erroneous radiological interpretation.• In blunt trauma, the anatomical biomechanical demands of the ligaments warrant consideration.• Dedicated MRI sequences can provide accurate evaluation of ligamentous integrity and injury.• Injury of the craniocervical junction carries risk of blunt traumatic cerebrovascular injury.

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MDCT of acute subaxial cervical spine trauma: a mechanism-based approach

Cited by 42 publications

References 35 publications

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7)

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma

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