Learning objectives
To familiarise musculoskeletal radiologists with cervical spine injury classification systems such as Allen and Fergusson,
SLIC and AOSpine classification.
To standardise terminology for cervical spine injuries in order to facilitate smooth and efficient communication with clinicians in the acute trauma setting.
To provide a time-efficient and comprehensive step-by-step algorithm for evaluation of the cervical spine injury and brieflydiscuss the ACR Appropriateness Criteria for imaging of cervical spine.
To provide a checklist for standardised reporting of the cervical spine injury.
To present different types of injuries...
Background
GENERAL INFORMATION
Traumatic cervical spine injuries belong to the daily routine of emergency radiologist and orthopedic spine surgeon.
With approximate amount of $ 5.6 billion spent yearly for treatment (i.e.
tetraplegia),cervical spine injuriesbelong to themost costly traumas.
Most common injuriesoccur in the subaxial cervical spine,
which range from the C3 to C7.
Potential severe complications include dorsal fracture dislocation and spinal cord injury,
which may result in tetraplegia,
neurologic failure and respiratory complications.
For that reason,
meticulous radiological and clinical assessment and consistent reporting systems...
Imaging findings OR Procedure Details
ACR APPROPRIATENESS CRITERIA
American College of Radiology (ACR) has released Appropriateness Criteria for imaging of the cervical spine in case of suspected trauma.
Different variantsarepresented,
dependent on the clinical and neurological status of the patient.
Common scenarios in case ofsuspectedcervical spine trauma (positive clinical crtieria of NEXUS/CCR) include:
Unspecific clinical status (Fig.
10)
Unenhanced CT of cervical spine should be performed.
This examination has a rating of 9 in the ACR scale(1-9) and isconsidered as a "usually appropriate" imaging modality.
Patient with myelopathy,suspectedtraumatic spinal cord...
Conclusion
In the acute setting,
when time plays a crucial role,
consistent communication with orthopedic surgeons is essential for optimal therapy management and patient care.
Understanding classification systems for cervical spine injuries contributes to smooth and fast cooperation of radiologistsandreferring physicians.
References
Bracken MB,
Freeman DH,
Hellenbrand K (1981) Incidence of acute traumatic hospitalized spinal cord injury in the United States,
1970–1977.
American journal of epidemiology 113:615-622
Berkowitz M (1993) Assessing the socioeconomic impact of improved treatment of head and spinal cord injuries.
J Emerg Med 11 Suppl 1:63-67
Vaccaro AR,
Hulbert RJ,
Patel AA et al.
(2007) Spine Trauma Study Group.
The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology,
neurology,
and integrity of the disco-ligamentous complex.
Spine.
32:2365–2374...
Personal Information
This electronic presentation (EPOS) on cervical spine trauma was possible thanksto theintensive workbetween radiologists and orthopedic surgeons.
We believe that teamworkcontributes to the highest qualityand is utterlyenjoyable,
even if the taskthat needs to be done is a hard and time-consuming one.
Feedback fromorthopedic surgeonsis crucial for musculoskeletal radiologists who search for constant improvement throughclose cooperation with clinicians.
Therefore,
we would appreciate anycomments or ideas you might have on our EPOS.
Please feel free to contact us at:
[email protected]
Thank youfor takingyourtime.