Hagedorn John C, Emery Sanford E, France John C, Daffner Scott D
Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J.C. Hagedorn II:
J Bone Joint Surg Am. 2014 Jun 4;96(11):951-955. doi: 10.2106/JBJS.M.00036.
Cervical injury can be associated with vertebral artery injury. This study was performed to determine the impact of computed tomography (CT) angiography of the head and neck on planning treatment of cervical spine fracture, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast medium.
This retrospective review included all patients who underwent CT of the cervical spine and CT angiography of the head and neck from January 2010 to August 2011 at one institution. Patients were divided into those with and those without cervical spine fracture seen on CT of the cervical spine. We determined if the CT angiography of the head and neck was positive for vascular injury in the patients with a cervical fracture. Vascular injury treatment and alterations in surgical fracture treatment due to positive CT angiography of the head and neck were recorded. A scan was deemed appropriate if it had been ordered per established institutional protocol.
Of the 381 patients who underwent CT angiography of the head and neck, 126 had a cervical injury. Sixteen of the CT angiography studies were appropriately ordered for non-spinal indications, and twenty-three were inappropriately ordered. The CT angiography was positive for one patient for whom the imaging was off protocol and one for whom the indication was non-spinal. Nineteen patients had positive CT angiography of the head and neck; no patient underwent surgical intervention for a vascular lesion. Eleven patients underwent surgical intervention for a cervical fracture; the operative plan was changed because of vascular injury in one case. The CT angiography was positive for eleven of forty-eight patients who had sustained a C2 fracture; this group accounted for eleven of the nineteen positive CT angiography studies. Noncontiguous injuries occurred in nineteen patients; three had positive CT angiography of the head and neck. The approximate charge for the CT angiography was $3925, radiation exposure was approximately 4000 mGy/cm, and contrast-medium load was approximately 100 mL.
Positive CT angiography of the head and neck rarely altered surgical treatment of cervical spine injuries. This study supports the findings in the literature that C1-C3 spine injuries have an increased association with vertebral artery injury. CT angiography of the head and neck ordered off protocol had a low likelihood of being positive. Strict adherence to protocols for CT angiography of the head and neck can reduce costs and decrease unnecessary exposure to radiation and contrast medium.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
颈椎损伤可能与椎动脉损伤相关。本研究旨在确定头颈部计算机断层扫描（CT）血管造影对颈椎骨折治疗方案规划的影响（前提是这些检查的医嘱开具恰当），并估算其成本以及辐射和造影剂的相关暴露量。
本回顾性研究纳入了2010年1月至2011年8月在某一机构接受颈椎CT及头颈部CT血管造影的所有患者。患者被分为颈椎CT检查发现有颈椎骨折和无颈椎骨折两组。我们判断颈椎骨折患者的头颈部CT血管造影是否显示血管损伤阳性。记录血管损伤的治疗情况以及因头颈部CT血管造影阳性而导致的手术骨折治疗方案的改变。如果按照既定的机构方案开具医嘱，则该扫描被视为恰当。
在381例行头颈部CT血管造影的患者中,126例有颈椎损伤。16例头颈部CT血管造影检查因非脊柱相关指征医嘱开具恰当，23例医嘱开具不恰当。1例成像不符合方案且1例指征为非脊柱相关的患者，其头颈部CT血管造影显示阳性。19例患者头颈部CT血管造影呈阳性；无患者因血管病变接受手术干预。11例患者因颈椎骨折接受手术干预；其中1例因血管损伤改变了手术方案。在48例发生C2骨折的患者中，11例头颈部CT血管造影呈阳性；这一组占19例头颈部CT血管造影阳性检查中的11例。19例患者存在非连续性损伤；3例头颈部CT血管造影呈阳性。头颈部CT血管造影的大致费用为3925美元，辐射暴露量约为4000 mGy/cm，造影剂用量约为100 mL。
头颈部CT血管造影阳性很少改变颈椎损伤的手术治疗方案。本研究支持文献中的研究结果，即C1 - C3脊柱损伤与椎动脉损伤的相关性增加。不符合方案开具医嘱的头颈部CT血管造影呈阳性的可能性较低。严格遵守头颈部CT血管造影方案可以降低成本，并减少不必要的辐射和造影剂暴露。
预后性证据四级。有关证据水平的完整描述，请参见作者指南。
