straightening of cervical spine radiology

However, plain film radiography remains a first-line imaging modality used in the evaluation of patients with suspected cervical spine injury prior to transfer for cross-sectional imaging. Straightening of the C-spine alone is not a definitive sign of injury but is a biomechanical variation due to CCI and neck positioning during MDCT or active patient control. In the group with CCI (CCI+), there was a significantly higher number of patients with a straight C-spine alignment (69% vs 49%, p = 0.05). In the two CCI−/CCI+ study groups, the straight or kyphotic alignment significantly (p = 0.001) predominated over lordosis. B, AP view, radiographic examination of the cervical spine.Rotational injuries and fractures of the lateral masses may be evident. In both trauma patient groups, but mainly among patients with CCI+, it was also noted that sharp segmental lordosis was mostly visualized because of negative (lordotic) angulation for the C2/3 or C6/7 segments in otherwise generally straight C-spine alignments (Figure 5). They concluded that the T1 slope from CR is significantly correlated with the T1 slope from MDCT, and so it may be used as a guide for the assessment of the sagittal balance of the C-spine in MDCT. Recently, low-dose MDCT protocols were developed and promoted for the use in C-spine imaging, leading to a rapid decrease of the use of CR for C-spine trauma patients in many emergency departments. The emerging role of MDCT in C-spine evaluation raised the question as to what extent changes in C-spine alignment may be considered normal for immobilized and non-immobilized patients after trauma. Straightening of the cervical spine in the acute setting may be secondary to muscular trauma, and a focal kyphosis may ensue at a later time. From this pool, 160 continuous MDCT examinations (study group) that met the following criteria were considered for the study: The study group was divided into two subgroups: (1) with CCI (, MDCT was performed on two 64-row scanners (VCT64 and HD750; GE, Milwaukee, WI) using a standard scanning protocol for patients with a suspected C-spine trauma: 120 kV, native helical scan with. These patients were classified according to defined ARA values as “lordotic”, although upon subjective visual assessment, they could be classified as “straight”. Among patients with and without CCI, non-lordotic C-spine curves, either straight or kyphotic, statistically significantly (p = 0.001) predominated over lordotic alignment. In this group, 35% (n = 6) of the patients revealed a lordotic alignment (mean 22.00; SD 6.39°), 60% of the patients (n = 12) revealed a straight C-spine alignment (mean 5.75; SD 5.01°), and one patient (5%) had a kyphotic alignment (+14°). It was also observed that in both trauma patient groups, straight alignment and segmental kyphosis appeared in 19–21% of the cases, and it was more common at the C5/6 segment. A new precision measurement protocol and normal motion data of healthy adults, Mean age (years) irrespective of gender (SD), Signs of initial degenerative spine disease (%), Mean age (years) for patients with initial degenerative spine disease (SD). Having been accepted as the imaging modality of choice for cases of multiple trauma for more than a decade, MDCT is now also the preferred imaging modality for single-trauma cases among adult patients. The ARA measurements for the patient groups with and without CCI showed predominantly straight alignments (69%) (ARA −13 to +6°) vs lordosis (21%) and kyphosis (10%). Therefore, the data drawn from this study could not be compared with other authors using MDCT, and a comparison with other studies based on upright CR imaging is methodically difficult and limited in this context. Cervical Spine Trauma: Pearls and Pitfalls Accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervi-cal spine CT, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings. Following today's established clinical indication guidelines such as the National Emergency X-Radiography Utilization Study (NEXUS) and Canadian Cervical Spine Rule (CCR), which are based on comprehensive prospective multicentre studies; CR imaging can be used instead of CT only for neurologically intact and alert patients, who are considered low risk. We suppose that the straight alignment of the C3–C5 segments in these patients was due to CCI impact, but the most proximal or distal segments of the C-spine remained partially mobile, probably because the cervical collar was not fastened tightly, hence the angulation result in a generally straightened C-spine. However, it shows that C-spine alignment in MDCT is intraindividually variable, most likely depending on the patient's position on the CT table, as other factors remained unchanged. A thorough survey of the literature on this topic revealed controversial opinions on the significance of a “normal” cervical curve in lateral CR radiographs.7,17–21. Axial T2 Large left posterior paracentral and lateral recess disc extrusion at C5/6 level resulting in indentation of thecal sac and stenosis of the corresponding left neural foramina. A cut-off age of 50 years was imposed to exclude age-dependent degenerative changes of the C-spine, which can impair the normal alignment before traumano obvious signs of injury to the head, neck and spine; exclusion of skull and vertebral fractures as well as intra- and extra-axial haematoma and ligamentous injuries, which can alter the alignment by itself. Loss of lordosis and straightening are often considered to be signs of muscular strain of the C-spine and have served as an indirect sign of cervical trauma or distortion in CR imaging for a long time. The comparison with the control group supports our hypothesis that straightening of the C-spine alignment curve in adult single C-spine trauma patients could be considered a biomechanical variation due to neck and shoulder girdle positioning during MDCT scanning or active patient C-spine control. There are no published scientific data to date based on supine MDCT C-spine alignment measurements among trauma patients with or without CCI. Figure 5. [In German. Age- and sex-matched control subjects with cervical spine MR imaging findings reported as normal were selected from the PACS. We suppose that the straight alignment of the C3–C5 segments in these patients was due to CCI impact, but the most proximal or distal segments of the C-spine remained partially mobile, probably because the cervical collar was not fastened tightly, hence the angulation result in a generally straightened C-spine. need for diagnostic imaging after head and/or neck trauma according to established clinical decision rules—the National Emergency X-Radiography Utilization Study and CCR—which were in use at our Level 1 trauma centre, MDCT imaging performed on a 64-row MDCT scanner using a standard C-spine protocol within 1 h after admission, patient age: 18–50 years. This supports an earlier stated hypothesis of the stabilizing and therefore straightening effect of CCI on the C-spine. In a healthy spine, your neck should look like a very wide C, with the curve pointing toward the back of your neck. ARAs C2–7 were obtained, and maximum and minimum values were calculated for all groups. The number of patients with straight C-spine alignment was higher in the CCI+ group (CCI+ 69% vs CCI− 49%, p = 0.05). A consecutive series of 900 patient files with suspected C-spine trauma were initially extracted from the institutional radiology information system. We aimed to define the normal anatomic variability in MDCT in a screening population after trauma with and without CCI and in comparison with a non-trauma control group; obvious injuries were initially excluded. The relative rotational angle (RRA) was determined by measurements of the posterior surface of neighbouring segments and were significant at >±4°.19, As no definite C-spine curve angles and cut-off values have been reported in literature so far for patients in the supine position undergoing MDCT with or without CCI, values for ARA C2–7 were adapted from literature data for patients undergoing upright CR imaging.7,17,19,24,25. Two independent readers evaluated retrospectively the alignment, determined the absolute rotational angle of the posterior surface of C2 and C7 (ARA C2–7) and grouped the results for lordosis (<−13°), straight (−13 to +6°) and kyphosis (>+6°). Based on the ARA value, patients were classified as lordotic, kyphotic or straight. The detailed results for the control group are shown in Table 2 and Figure 2. The absolute rotational angle of the posterior surface of C2 and C7 (ARA C2–7) (. Axial MRI C5-C6. Having been accepted as the imaging modality of choice for cases of multiple trauma for more than a decade, MDCT is now also the preferred imaging modality for single-trauma cases among adult patients.8–10 The American College of Radiology (ACR), too, recently stated in its appropriateness criteria that MDCT is the imaging modality of choice for adult single C-spine trauma. These treatments than 85 percent of people older than age 60 are affected by cervical spondylosis.Most people no. 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Crawling position sign in screening trauma patients undergoing MDCT low back all have counterbalanced curves criteria were applied, applicable... The control group are shown in Table 3 shown in Table 2 and Figure 2 becoming increasingly important C-spine...

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