Spiral Computed Tomography for the Initial Evaluation of Spine Trauma: A New Standard of Care?

Antevil, Jared L.; Sise, Michael J.; Sack, Daniel I.; Kidder, Brendan; Hopper, Andrew; Brown, Carlos

doi:10.1097/01.ta.0000226154.38852.e6

Cited by 128 publications

(72 citation statements)

References 36 publications

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“…CT with low-radiation dose has been recently shown to be a reliable method in the assessment of pedicle screw placement with substantial interobserver and intraobserver agreements [6]. Furthermore, the radiation dose of plain radiography of spine varies in different reports and in some studies is reported to be as high as 26 mSv [7] compared with 0.37 mSv for the low-dose spine CT in that study [6]. The risk for development of lethal cancer is calculated to be 5% per Sievert [8].…”

Section: Introductionmentioning

confidence: 99%

Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography

et al. 2009

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Posterior corrective surgery using ''all pedicle screw construct'' carries risk of neurovascular complications. The study aims were to assess the screw placement in patients with adolescent idiopathic scoliosis using CT with low-radiation dose, and to evaluate the clinical outcome in patients with misplaced pedicle screws. CTs of 49 consecutive patients (873 screws, 79% thoracic) were retrospectively evaluated by two independent radiologists. A new grading system was developed to distinguish between lateral, medial and anterior cortical perforations, endplate perforation and foraminal perforation. The grading system is based on whether the cortical violation is partial or total rather than on mm-basis. The overall rate of screw misplacement was 17% (n = 149): 8% were laterally placed and 6.1% were medially placed. The rates of anterior cortical, endplate and foraminal perforation were 1.5, 0.9, and 0.5%, respectively. Lateral cortical perforation was more frequent in the thoracic spine (P = 0.005), whereas other types of misplacement including medial cortical perforation were more frequent on the left and the concave side of scoliotic curves (P = 0.002 and 0.003). No neurovascular complications were reported. The association between the occurrence of screw misplacement and the Cobb angle was statistically significant (P = 0.037). Misplacements exceeding half screw diameter should be classified as unacceptable. Low-dose CT implies exposing these young individuals to a significantly lower radiation dose than do other protocols used in daily clinical practice. We recommend using low-dose CT and the grading system proposed here in the postoperative assessment of screw placement.

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Section: Introductionmentioning

confidence: 99%

Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography

et al. 2009

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“…CT screening has a higher sensitivity and specificity for evaluating cervical spine injury compared with plain film radiographs [25,27,28]. In the cervical spine, CT detects 97-100% of fractures, but its accuracy in detection of purely ligamentous injuries has not been documented [23].…”

Section: (Multidetector) Computed Tomographymentioning

confidence: 99%

“…An additional advantage is that CT allows more rapid radiological clearance of the cervical spine than radiography [27,28]. For these reasons, many major trauma centers nowadays have replaced plain film radiographs with spiral CT or MDCT as the standard of care in the initial evaluation of the cervical spine in moderate to severe trauma patients [27].…”

Section: (Multidetector) Computed Tomographymentioning

confidence: 99%

“…For these reasons, many major trauma centers nowadays have replaced plain film radiographs with spiral CT or MDCT as the standard of care in the initial evaluation of the cervical spine in moderate to severe trauma patients [27]. Although CT, and especially MDCT, is more costly than plain radiographs, it has been shown that it can actually decrease institutional costs (when settlement costs are taken into account) due to the reduction of the incidence of paralysis resulting from falsenegative imaging studies [30].…”

Section: (Multidetector) Computed Tomographymentioning

confidence: 99%

“…At the time of injury, the average age of patients with traumatic spine lesions is 32 years and 55% of those injured are aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] years. Approximately, half of spinal injuries occur in the cervical spine, the other half involves the thoracic, lumbar, and sacral areas.…”

Section: Introductionmentioning

confidence: 99%

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Trauma of the spine and spinal cord: imaging strategies

et al. 2009

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Traumatic injuries of the spine and spinal cord are common and potentially devastating lesions. We present a comprehensive overview of the classification of vertebral fractures, based on morphology (e.g., wedge, (bi)concave, or crush fractures) or on the mechanism of injury (flexion-compression, axial compression, flexiondistraction, or rotational fracture-dislocation lesions). The merits and limitations of different imaging techniques are discussed, including plain X-ray films, multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI) for the detection. There is growing evidence that state-of-the-art imaging techniques provide answers to some of the key questions in the management of patients with spine and spinal cord trauma: is the fracture stable or unstable? Is the fracture recent or old? Is the fracture benign or malignant? In summary, we show that high-quality radiological investigations are essential in the diagnosis and management of patients with spinal trauma.

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Radiologic Evaluation Of Skeletal Metastases: Role Of Plain Radiographs And Computed Tomography

2009

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Spiral Computed Tomography for the Initial Evaluation of Spine Trauma: A New Standard of Care?

Cited by 128 publications

References 36 publications

Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography

Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography

Trauma of the spine and spinal cord: imaging strategies

Radiologic Evaluation Of Skeletal Metastases: Role Of Plain Radiographs And Computed Tomography

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