Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
Spine (Phila Pa 1976). 2013 Feb 15;38(4):E211-6. doi: 10.1097/BRS.0b013e31827f0dc3.
Retrospective cohort study.
To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma.
In adult patients with trauma, an increase in the thickness of the retropharyngeal soft tissues is commonly used as a potential indicator of occult injury, but no studies have examined this parameter using computed tomography (CT) as a screening modality.
A total of 541 patients with trauma with injuries at any level of the spine underwent CT. Patients with cervical injury were divided into those requiring noninvasive (observation or cervical collar, n = 142) management, and those requiring invasive (surgery or halo, n = 61) treatment. A control group of patients with isolated thoracic or lumbar injuries was used for comparison (n = 542). Retropharyngeal soft tissues were measured at the cranial and caudal endplates of all cervical levels on sagittal and axial CT. Sensitivity and specificity were calculated for +1, +2, and +3 standard deviations from mean values.
Sensitivity for detection of injury was found to be universally poor for all measurement groups. This ranged from 14.4% to 21.2% at +1 SD to 5.3% to 8.7% at +2 SD. Positive and negative predictive values for injury were also universally poor, ranging from 38% to 75%. Soft-tissue swelling as a sentinel sign of cervical spine injury demonstrates consistently high specificity and low sensitivity, precisely the opposite of what would be desired in a screening test. This study shows at best a sensitivity of 21.6% when using this parameter for the detection of these injuries in adult patients with trauma.
On the basis of the results of this study, we recommend against the routine use of measurement of the prevertebral soft tissues on CT as a screening tool for cervical spine injury in adult patients with trauma.
回顾性队列研究。
探讨颈椎创伤时椎前软组织肿胀的诊断价值。
在创伤的成年患者中，咽后软组织厚度的增加通常被用作隐匿性损伤的潜在指标，但尚无研究使用计算机断层扫描（CT）作为筛查手段来检查该参数。
共对 541 例脊柱各部位创伤患者行 CT 检查。颈椎损伤患者分为非侵入性（观察或颈圈，n = 142）和侵入性（手术或 halo，n = 61）治疗。同时设立单纯胸腰椎损伤患者对照组（n = 542）。在矢状位和轴位 CT 上测量所有颈椎水平的颅端和尾端终板的咽后软组织。计算+1、+2 和+3 个标准差平均值的敏感度和特异度。
所有测量组对损伤的检测敏感度普遍较差。从+1 SD 的 14.4%到+2 SD 的 5.3%到+3 SD 的 8.7%。阳性和阴性预测值对损伤的评估也普遍较差，范围从 38%到 75%。作为颈椎损伤的哨兵征象，椎前软组织肿胀表现出始终较高的特异性和较低的敏感度，这与筛查试验所需的情况正好相反。本研究表明，在创伤的成年患者中，使用该参数检测这些损伤的敏感度最高为 21.6%。
基于本研究的结果，我们不建议将 CT 上椎前软组织的测量常规用作创伤成年患者颈椎损伤的筛查工具。
3 级。
