Trauma Imaging of the Acute Cervical Spine

Daniela Berritto; Antonio Pinto; Paul Michelin; Xavier Demondion; Sammy Badr

doi:10.1055/s-0037-1602713

Seminars in Musculoskeletal Radiology, Inhaltsverzeichnis

Semin Musculoskelet Radiol 2017; 21(03): 184-198
DOI: 10.1055/s-0037-1602713

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Trauma Imaging of the Acute Cervical Spine

Authors

Daniela Berritto

¹Department of Radiology, Private Hospital “Villa dei Fiori,” Acerra, Naples, Italy
Antonio Pinto

²Department of Radiology, Cardarelli Hospital, Naples, Italy
Paul Michelin

³Department of Radiology, University Hospital of Rouen, Rouen, France
Xavier Demondion

⁴Department of Musculoskeletal Radiology, CHU Lille, Lille, France
Sammy Badr

⁴Department of Musculoskeletal Radiology, CHU Lille, Lille, France

Abstract

Among patients admitted in emergency departments for acute cervical spine trauma, only a few have a confirmed and significant injury requiring surgical intervention. Imaging plays a key role in screening for unstable lesions that can be responsible for devastating neurologic complications or death. The complex anatomy of the cervical spine is associated with a wide spectrum of osseous and ligamentous pathologies. This review focuses on the imaging features of the main cervical spine fractures that can be encountered in emergency radiology.

Keywords

cervical spine - trauma - diagnostic imaging - emergency radiology

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References
1 Lenehan B, Boran S, Street J, Higgins T, McCormack D, Poynton AR. Demographics of acute admissions to a National Spinal Injuries Unit. Eur Spine J 2009; 18 (07) 938-942
2 Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR. ; NEXUS Group. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med 2001; 38 (01) 17-21
3 Greenbaum J, Walters N, Levy PD. An evidenced-based approach to radiographic assessment of cervical spine injuries in the emergency department. J Emerg Med 2009; 36 (01) 64-71
4 Varma A, Hill EG, Nicholas J, Selassie A. Predictors of early mortality after traumatic spinal cord injury: a population-based study. Spine 2010; 35 (07) 778-783
5 Inaba K, Byerly S, Bush LD. , et al; WTA C-Spine Study Group. Cervical spinal clearance: a prospective Western Trauma Association Multi-Institutional Trial. J Trauma Acute Care Surg 2016; 81 (06) 1122-1130
6 Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. ; National Emergency X-Radiography Utilization Study Group. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000; 343 (02) 94-99
7 Stiell IG, Clement CM, McKnight RD. , et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003; 349 (26) 2510-2518
8 Stiell IG, Wells GA, Vandemheen KL. , et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001; 286 (15) 1841-1848
9 Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J 2009; 18 (02) 145-156
10 Daffner RH, Hackney DB. ACR Appropriateness Criteria on suspected spine trauma. J Am Coll Radiol 2007; 4 (11) 762-775
11 Bailitz J, Starr F, Beecroft M. , et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma 2009; 66 (06) 1605-1609
12 Blackmore CC, Ramsey SD, Mann FA, Deyo RA. Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis. Radiology 1999; 212 (01) 117-125
13 Daffner RH. Cervical radiography for trauma patients: a time-effective technique?. AJR Am J Roentgenol 2000; 175 (05) 1309-1311
14 Ryken TC, Hadley MN, Walters BC. , et al. Radiographic assessment. Neurosurgery 2013; 72 (Suppl. 02) 54-72
15 Rozzelle CJ, Aarabi B, Dhall SS. , et al. Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 2013; 72 (Suppl. 02) 205-226
16 Daffner RH, Harris JH. Cervical Spine Injuries. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013: 139-260
17 Hanson JA, Deliganis AV, Baxter AB. , et al. Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients. AJR Am J Roentgenol 2002; 178 (05) 1261-1268
18 Garrett M, Consiglieri G, Kakarla UK, Chang SW, Dickman CA. Occipitoatlantal Dislocation. Neurosurgery 2010; 66 (03) (Suppl. 03) A48-A55
19 Karam YR, Traynelis VC. Occipital condyle fractures. Neurosurgery 2010; 66 (03) (Suppl. 03) A56-A59
20 Klimo Jr P, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. Neurosurg Clin N Am 2007; 18 (03) 463-478
21 Lustrin ES, Karakas SP, Ortiz AO. , et al. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics 2003; 23 (03) 539-560
22 Harris Jr JH, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994; 162 (04) 881-886
23 Harris Jr JH, Carson GC, Wagner LK, Kerr N. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994; 162 (04) 887-892
24 Wholey MH, Bruwer AJ, Baker Jr HL. The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 1958; 71 (03) 350-356
25 Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine 1988; 13 (07) 731-736
26 Ahuja A, Glasauer FE, Alker Jr GJ, Klein DM. Radiology in survivors of traumatic atlanto-occipital dislocation. Surg Neurol 1994; 41 (02) 112-118
27 Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery 1997; 41 (02) 368-376 ; discussion 376–377
28 Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VK, Theodore N. Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates. J Neurosurg Spine 2007; 6 (02) 113-120
29 Steinmetz MP, Lechner RM, Anderson JS. Atlantooccipital dislocation in children: presentation, diagnosis, and management. Neurosurg Focus 2003; 14 (02) ecp1
30 Theodore N, Aarabi B, Dhall SS. , et al. The diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery 2013; 72 (Suppl. 02) 114-126
31 Diagnosis and Management of Traumatic Atlanto-occipital Dislocation Injuries. Neurosurgery 2002; 50 (Suppl. 03) S105-S113
32 Rojas CA, Bertozzi JC, Martinez CR, Whitlow J. Reassessment of the craniocervical junction: normal values on CT. AJNR Am J Neuroradiol 2007; 28 (09) 1819-1823
33 Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler Jr JA. Traumatic anterior atlanto-occipital dislocation. Neurosurgery 1979; 4 (01) 12-17
34 Lee C, Woodring JH, Goldstein SJ, Daniel TL, Young AB, Tibbs PA. Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 1987; 8 (01) 19-26
35 Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 1986; 65 (06) 863-870
36 Marcon RM, Cristante AF, Teixeira WJ, Narasaki DK, Oliveira RP, de Barros Filho TE. Fractures of the cervical spine. Clinics (Sao Paulo) 2013; 68 (11) 1455-1461
37 Jefferson G. Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. Br J Surg 1919; 7 (27) 407-422
38 Matthiessen C, Robinson Y. Epidemiology of atlas fractures--a national registry-based cohort study of 1,537 cases. Spine J 2015; 15 (11) 2332-2337
39 Kakarla UK, Chang SW, Theodore N, Sonntag VK. Atlas fractures. Neurosurgery 2010; 66 (03) (Suppl. 03) A60-A67
40 Hadley MN, Dickman CA, Browner CM, Sonntag VK. Acute traumatic atlas fractures: management and long term outcome. Neurosurgery 1988; 23 (01) 31-35
41 Gehweiler J, Duff D, Martinez S, Miller MD, Clark WM. Fractures of the atlas vertebra. Skeletal Radiol 1976; 1 (02) 97-102
42 Landells CD, Van Peteghem PK. Fractures of the atlas: classification, treatment and morbidity. Spine 1988; 13 (05) 450-452
43 Radcliff KE, Sonagli MA, Rodrigues LM, Sidhu GS, Albert TJ, Vaccaro AR. Does C₁ fracture displacement correlate with transverse ligament integrity?. Orthop Surg 2013; 5 (02) 94-99
44 Harrop JS, Sharan AD, Przybylski GJ. Epidemiology of spinal cord injury after acute odontoid fractures [abstract]. Neurosurg Focus 2000; 8 (06) e4
45 Pepin JW, Bourne RB, Hawkins RJ. Odontoid fractures, with special reference to the elderly patient. Clin Orthop Relat Res 1985; (193) 178-183
46 Ryan MD, Taylor TK. Odontoid fractures in the elderly. J Spinal Disord 1993; 6 (05) 397-401
47 Anderson LD, D'Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974; 56 (08) 1663-1674
48 Wilson J, Harrop J. Update on upper cervical spine injury classifications. Semin Spine Surg 2017; 29 (01) 9-13
49 Pal D, Sell P, Grevitt M. Type II odontoid fractures in the elderly: an evidence-based narrative review of management. Eur Spine J 2011; 20 (02) 195-204
50 Roy-Camille R, Saillant G, Judet T, de Botton G, Michel G. Factors of severity in the fractures of the odontoid process [in French]. Rev Chir Orthop Repar Appar Mot 1980; 66 (03) 183-186
51 Rozzelle CJ, Aarabi B, Dhall SS. , et al. Os odontoideum. Neurosurgery 2013; 72 (Suppl. 02) 159-169
52 Ryken TC, Hadley MN, Aarabi B. , et al. Management of isolated fractures of the axis in adults. Neurosurgery 2013; 72 (03) (Suppl. 02) 132-150
53 Gleizes V, Jacquot FP, Signoret F, Féron JM. Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period. Eur Spine J 2000; 9 (05) 386-392
54 Garber JN. Abnormalities of the atlas and axis vertebrae—congenital and traumatic. J Bone Joint Surg Am 1964; 46 (08) 1782-1791
55 Barros TE, Bohlman HH, Capen DA. , et al. Traumatic spondylolisthesis of the axis: analysis of management. Spinal Cord 1999; 37 (03) 166-171
56 Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br 1981; 63-B (03) 319-327
57 Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 1985; 67 (02) 217-226
58 Passias PG, Wang S, Kozanek M, Wang S, Wang C. Relationship between the alignment of the occipitoaxial and subaxial cervical spine in patients with congenital atlantoxial dislocations. J Spinal Disord Tech 2013; 26 (01) 15-21
59 Yin Y-H, Qiao G-Y, Yu X-G, Tong H-Y, Zhang Y-Z. Posterior realignment of irreducible atlantoaxial dislocation with C1-C2 screw and rod system: a technique of direct reduction and fixation. Spine J 2013; 13 (12) 1864-1871
60 Sobolewski BA, Mittiga MR, Reed JL. Atlantoaxial rotary subluxation after minor trauma. Pediatr Emerg Care 2008; 24 (12) 852-856
61 Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries [abstract]. Neurosurgery 1996; 38 (01) 44-50
62 Jackson RS, Banit DM, Rhyne III AL, Darden II BV. Upper cervical spine injuries. J Am Acad Orthop Surg 2002; 10 (04) 271-280
63 Wang S, Wang C, Yan M, Zhou H, Dang G. Novel surgical classification and treatment strategy for atlantoaxial dislocations. Spine 2013; 38 (21) E1348-E1356
64 Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint) [abstract]. J Bone Joint Surg Am 1977; 59 (01) 37-44
65 Kowalski HM, Cohen WA, Cooper P, Wisoff JH. Pitfalls in the CT diagnosis of atlantoaxial rotary subluxation. AJR Am J Roentgenol 1987; 149 (03) 595-600
66 Vaccaro AR, Hulbert RJ, Patel AA. , et al; 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 2007; 32 (21) 2365-2374
67 Aarabi B, Walters BC, Dhall SS. , et al. Subaxial cervical spine injury classification systems. Neurosurgery 2013; 72 (Suppl. 02) 170-186
68 Favero KJ, Van Peteghem PK. The quadrangular fragment fracture. Roentgenographic features and treatment protocol. Clin Orthop Relat Res 1989; 239 (239) 40-46
69 Korres D, Benetos I, Evangelopoulos D. , et al. Tear-drop fractures of the lower cervical spine: classification and analysis of 54 cases. Eur J Orthop Surg Traumatol 2007; 17 (06) 521-526
70 Allen Jr BL, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine 1982; 7 (01) 1-27
71 Anderson SE, Boesch C, Zimmermann H. , et al. Are there cervical spine findings at MR imaging that are specific to acute symptomatic whiplash injury? A prospective controlled study with four experienced blinded readers. Radiology 2012; 262 (02) 567-575
72 Palmieri F, Cassar-Pullicino VN, Dell'Atti C. , et al. Uncovertebral joint injury in cervical facet dislocation: the headphones sign. Eur Radiol 2006; 16 (06) 1312-1315
73 Shanmuganathan K, Mirvis SE, Levine AM. Rotational injury of cervical facets: CT analysis of fracture patterns with implications for management and neurologic outcome. AJR Am J Roentgenol 1994; 163 (05) 1165-1169
74 Hirsh LF, Duarte LE, Wolfson EH, Gerhard W. Isolated symptomatic cervical spinous process fracture requiring surgery. Case report. J Neurosurg 1991; 75 (01) 131-133
75 Meyer PG, Hartman JT, Leo JS. Sentinel spinous process fractures. Surg Neurol 1982; 18 (03) 174-178
76 Solaroğlu I, Kaptanoğlu E, Okutan O, Beşkonakli E. Multiple isolated spinous process fracture (Clay-shoveler's fracture) of cervical spine: a case report. Ulus Travma Acil Cerrahi Derg 2007; 13 (02) 162-164