The overall sensitivity of conventional radiography (CR) for detecting C-spine injuries is only 39–52% compared with a sensitivity of 90–98% for multidetector CT (MDCT) reported in recent publications, the latter being by far superior to CR. © 2016 The Authors. 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. 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. In the group with CCI (CCI+), 69% (n = 55) of the patients revealed a straight alignment, 10% (n = 8) had a kyphotic alignment and 21% (n = 17) showed a lordotic alignment. Today, it is a clinically well-evaluated and evidence-based fact that MDCT is superior to CR regarding detection of C-spine injuries.4–7, MDCT is becoming increasingly important for C-spine trauma imaging for adults. car accident) may be a direct cause of straightening of the neck curve, there are other issues that may straighten our cervical spine … 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). Age- and sex-matched control subjects with cervical spine MR imaging findings reported as normal were selected from the PACS. The control group (n = 20), i.e. 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 lordosis Your neck, upper back, and low back all have counterbalanced curves. Control group: absolute rotational angle (ARA) C2–7 values (°). [In German. Reassessment of the craniocervical junction: normal values on CT, Sagittal plane segmental motion of the cervical spine. Hi I am having severe neck pain and numbness in hands and face and headache for last few days. 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 some cases, an artificial disc can be inserted instead of performing a … A thorough survey of the literature on this topic revealed controversial opinions on the significance of a “normal” cervical curve in lateral CR radiographs. A comparison of the patient groups with CCI (CCI+) and without CCI (CCI−) showed a slightly lower number of patients with either kyphotic (10% vs 18%, p = 0.34) or lordotic (21% vs 33%, p = 0.33) alignment, but these differences were not statistically significant. The SEM for the PTM Harrison (1° < SEM < 2°) is lower than the reported values for the Cobb method (3° < SEM < 10°), and it is considered to be both more reliable and reproducible. In 1975, Weir reviewed 360 asymptomatic patients and found 20 percent to have either straight or reversed cervical curves in … When the curve points toward the front, it’s called a lordosis and toward the back, it’s called a kyphosis. posterior d I just got my MRI report:Straightening of cervical lordossis. Motor vehicle collisions are the predominant mechanism in children under 8 years old; older children most commonly sustain sports-related injuries [].Child abuse should also be considered in the young child with a suspected whiplash mechanism of CSI. All studies mentioned, however, were based on upright CR studies only. As the standard of care for the diagnosis of C-spine trauma is shifting from CR to MDCT, a re-evaluation of normal anatomic alignment is needed. 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. 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. A spinal MRI, or magnetic resonance imaging, uses powerful magnets, radio waves, and a computer to make clear, detailed pictures of your spine. If straight and kyphotic alignments are pooled, there were no statistical differences (65% vs 67%) to the study group without CCI. At C2-C3 and C3-C4 subtle anterolisthesis. The latter is limited as an intraindividual observation. To our knowledge, no study has been performed to date to investigate changes in the C-spine alignment in MDCT imaging of the C-spine after trauma and as to whether CCI significantly influences the values of normal cervical lordosis measurements. A comparison of the CCI+ group vs the CCI− group revealed a slightly smaller number of kyphotic (10% vs 18%, p = 0.34) and lordotic (21% vs 33%, p = 0.33) alignments. The control group revealed no significant differences. Approximately 2–3% of all trauma patients in emergency departments suffer from cervical spine (C-spine) injury. The number of patients with straight C-spine alignment was higher in the CCI+ group (CCI+ 69% vs CCI− 49%, p = 0.05). Straightening of the C-spine alignment is related to neck positioning and active patient control. 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. 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. 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. For the purpose of these studies, however, imaging was performed in the upright position and mostly without CCI. Table 3. Cervical spine injury (CSI) is rare in children, accounting for only 1–2% of pediatric trauma. Table 1. A p-value ≤ 0.05 was considered to be statistically significant. 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. 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. Imaging of the cervical spine is a routine part of a radiology practice. Moreover, the clinician must be aware of the “false positive” sign: a straightened cervical curve or a reserved cervical curve not resulting from trauma or pain. Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. Following the analysis of our non-traumatized control group, we found that even in this group “straight” alignment in supine patients is statistically significantly predominant over lordotic alignment (60% vs 35%, respectively), and even if straight and kyphotic alignments were pooled, there were no statistical differences (control group 65% vs CCI− 67%) to the study group without CCI. The cervical spine … The SEM for the PTM Harrison (1° < SEM < 2°) is lower than the reported values for the Cobb method (3° < SEM < 10°), and it is considered to be both more reliable and reproducible.7,24 Therefore, in the present study PTM Harrison was used to evaluate changes in the C-spine curve. The condition describes a spinal state in which the normal lumbar or cervical region is reduced in its degree of front to back curvature, also medically known as hypolordosis. a Defined as mild narrowing of disc spaces, initial subchondral osseous sclerosis. Published by the British Institute of Radiology, Institute for Diagnostic and Interventional Radiology, HELIOS Clinic München West & München Perlach, Munich, Germany, Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany, Department of Radiology, University of Latvia, Riga, Latvia, Department of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy, European Society of Emergency Radiology (ESER), Vienna, Austria, 160 consecutive patients after C-spine trauma admitted to a Level 1 trauma centre received MDCT according to Canadian Cervical Spine Rule and National Emergency X-Radiography Utilization Study indication rule; subgroups with and without cervical collar immobilization (CCI +/−) were compared with a control group (, In the two CCI−/CCI+ study groups, the straight or kyphotic alignment significantly (. All studies mentioned, however, were based on upright CR studies only. Another group, Beltsios et al,22 recently studied the incidence of normal cervical lordosis among 60 and 100 healthy patients using MDCT and compared their results with the changes in patients with a neck injury, applying CR and MDCT. However, when there is … Fluid-sensitive sequences on MRI may show high signal in the posterior soft tissues, corresponding to … max., maximum; min., minimum; SD, standard deviation. 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. 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. One goes one way, and the adjoining curve goes the opposite way. This could also increase the number of “straight” C-spine cases among patients with CCI and the difference in C-spine alignment distribution between both trauma patient groups. Figure 5. A, Lateral view, radiographic examination of the cervical spine.Best visualizes fractures and dislocations. Therefore “straightening” of the C-spine alone should not be considered a reliable pathological imaging sign in screening trauma patients undergoing MDCT. 160 consecutive patients after C-spine trauma admitted to a Level 1 trauma centre received MDCT according to Canadian Cervical Spine Rule and National Emergency X-Radiography Utilization Study indication rule; subgroups with and without cervical collar immobilization (CCI +/−) were compared with a control group (n = 20) of non-traumatized patients. Based on prior published data, the following cut-off angle/alignment values were defined to group the patients as follows: lordosis <−13°; straight −13° to +6°; kyphosis >+6°. In addition, a control group (n = 20) of normal non-traumatized patients was established, aged 18–50 years, that underwent head/neck MDCT for oncologic imaging. Interobserver reliability and discrepancies in angle measurements between patient groups as well as patient sex, age and signs of initial degenerative spine disease were analysed and compared across all groups. 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%). The study group was divided into two subgroups: (1) with CCI (n = 80) and (2) without CCI (n = 80); for more details, see Table 1. Marshall et al26 reported a correlation of reduced cervical lordosis measurements following motor vehicle accidents, although the differences in lordosis values between analysed groups were not statistically significant. 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. 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. 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. Axial reconstructions were calculated with a slice thickness of 1.25 mm and a high-resolution bone kernel, 2.5 mm and a soft-tissue kernel, and 0.65 mm for multiplanar reconstructions, applying slice thickness of 2 mm in the coronal and sagittal orientations. 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). The number of patients with straight C-spine alignment was higher in the CCI+ group (CCI+ 69% vs CCI− 49%, p = 0.05). Straightening of the C-spine alignment is related to neck positioning and active patient control. Children randomly suffer from this problem. Begin to crawl and raise their heads in that straightening of cervical spine radiology position on measurements... This supports an earlier stated hypothesis of the posterior surface of C2 and (! 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