The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation

Gire, Jacob D.; Roberto, Rolando Figueroa; Bobinski, Matthew; Klineberg, Eric O.; Durbin‐Johnson, Blythe

doi:10.1016/j.spinee.2013.01.023

Cited by 54 publications

(36 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…7 (lower), the two lines are superimposed with what is practically an insignificant annual increase with age (0.001 mm/year). The condylar sum, obtained from the mean of each patient's RCCI and LCCI, was also shorter by 1.41 mm than the results obtained by Gire et al 7 (1.8 mm vs 3.21 mm). Contrary to the results of Pang et al, 18,19 our results showed that symmetry was not universally observed among non-AOD patients, and 7 of 59 patients had a difference greater than 20% between left and right sides.…”

Section: Normal CCIcontrasting

confidence: 54%

“…In a study from 2013, Gire et al 7 proposed 3 premises: 1) Normative data from the study by Pang et al 18,19 did not demonstrate a statistical change of CCI from birth to 18 years; therefore, the use of the CCI may also be applicable to adult populations. 2) The number of measurements taken should be reduced from 8 per joint to 1 to make the technique more practical.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have suggested that in adults a CCI ≥ 2 mm is abnormal. 5,26,28 More recently, Gire et al 7 proposed that a single measurement of the CCI ≥ 2.5 mm and/or a condylar sum ≥ 5 mm was indicative of AOD in their analysis of 10 patients (6 adults and 4 children). 7 We believe that an adequate study should attempt to identify the CCI in healthy adult patients and compare it with the CCI in adult patients with AOD.…”

mentioning

confidence: 99%

“…5,26,28 More recently, Gire et al 7 proposed that a single measurement of the CCI ≥ 2.5 mm and/or a condylar sum ≥ 5 mm was indicative of AOD in their analysis of 10 patients (6 adults and 4 children). 7 We believe that an adequate study should attempt to identify the CCI in healthy adult patients and compare it with the CCI in adult patients with AOD. Although a few studies address this topic, 28,30 to our knowledge, this paper presents the largest CT-based study evaluating normal and abnormal parameters for the CCI exclusively in the adult population.…”

mentioning

confidence: 99%

“…Although a few studies address this topic, 28,30 to our knowledge, this paper presents the largest CT-based study evaluating normal and abnormal parameters for the CCI exclusively in the adult population. We report the CCI for 59 adults without AOD and for 22 adults with AOD and compare their results with published radiological diagnostic criteria 7,10,15,18,19,23,27,31 to determine whether a highly sensitive and specific cutoff value for diagnosing AOD with neuroimaging studies can be defined.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Martinez-del-Campo

Kalb

Soriano-Baron

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECT Atlantooccipital dislocation (AOD) in adults cannot be diagnosed with adequate specificity and sensitivity using only CT or plain radiography, and the spine literature offers no guidelines. In children, the most sensitive and specific radiographic measurement for the diagnosis of AOD is the CT-based occipital condyle–C1 interval (CCI). The goal of the current study was to identify the normal CCI in healthy adults and compare it with the CCI in adults with AOD to establish a highly sensitive and specific cutoff value for the neuroimaging diagnosis of AOD. METHODS A total of 81 patients, 59 without AOD and 22 with AOD, were included in this study. Measurements obtained from thin-slice CT scans of the craniovertebral joint to assess atlantooccipital dislocation included the CCI, condylar sum, the Wholey and Harris intervals, Powers and Sun ratios, Wackenheim line, and Lee X-lines. RESULTS The group of patients without AOD included 30 men (50.8%) and 29 women (49.2%) with a mean age of 42.4 ± 16 years (range 19–87 years). The group of patients with AOD included 10 men (45.5%) and 12 women (54.5%) with a mean age of 38.2 ± 9.7 years (range 20–56 years). Interrater reliabilities within a 95% CI were all greater than 0.98 for CCI measurements. A total of 1296 measurements of the CCI were made in 81 patients. The mean CCI for non-AOD patients was 0.89 ± 0.12 mm, the single largest CCI measurement was 1.4 mm, and the largest mean for either right or left CCI was 1.2 mm. The mean condylar sum was 1.8 ± 0.2 mm, and the largest condylar sum value was 2.2 mm. Linear regression with age predicted an increase in CCI of 0.001 mm/year (p < 0.05). The mean CCI in AOD patients was 3.35 ± 0.18 mm (range 1.5 mm–6.4 mm). The shortest single CCI measurements in the AOD patients were 1.1 mm and 1.2 mm. The mean condylar sum for all 22 AOD patients was 6.7 ± 2.7 mm and the shortest condylar sums were 3.0 mm. Cutoff values for AOD were set at 1.5 mm for the CCI and 3.0 mm for the condylar sum, both with a sensitivity of 1 and false-negative rate of 0. Sensitivity for the Powers, Wholey, Harris, Sun, Wackenheim, and Lee criteria were determined to be 0.55, 0.46, 0.27, 0.23, 0.41, and 0.41, respectively. CONCLUSIONS The CCI is shorter in adult patients as opposed to the pediatric population. The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.