Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
Department of Neurological Surgery, University of Iowa, Carver School of Medicine, Iowa City, Iowa, United States.
Global Spine J. 2016 Sep;6(6):529-34. doi: 10.1055/s-0035-1569058. Epub 2015 Nov 26.
Retrospective study.
Traumatic atlanto-occipital dissociation (AOD) remains a diagnostic challenge, and delay in diagnosis is associated with catastrophic outcomes. Recently, a revised version of the condyl-C1 interval (CCI) utilizing parasagittal computed tomography (CT) reconstruction was used successfully with unilateral dislocation of 2.5 mm at the level of that joint diagnostic of AOD. We report the utility of this simple technique in the diagnosis of six patients with AOD.
Two blinded neurosurgeons assessed CTs of six patients with AOD and 30 patients without AOD. The following methodologies were applied: basion-dens interval (BDI), basion-axial interval (BAI), Lee X-lines, Powers ratio, CCI, and revised CCI. The average sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as well as the kappa statistic indicating interrater reliability of each method were investigated.
The average sensitivity for BDI, BAI, Lee X-lines, Power ratio, CCI, and revised CCI was 0.75, 0.33, 0.67, 0.50, 1.00, and 1.00, respectively. The average specificity was 1.00, 1.00, 0.50, 1.00, 0.94, and 1.00, respectively. The average PPV was 1.00, 1.00, 0.25, 1.00, 0.80, and 1.00, respectively. The average NPV was 0.96, 0.88, 0.89, 0.91, 1.00, and 1.00, respectively, and the kappa statistic was 0.57, 0.25, 0.25, 0.20, 1.00, and 1.00, respectively.
Based on this study, the revised CCI method is simple yet the most sensitive and reliable technique for the diagnosis of AOD.
回顾性研究。
创伤性寰枕关节分离（AOD）仍然是一个诊断挑战，诊断延迟与灾难性结果相关。最近，一种利用矢状位 CT 重建的改良寰枢关节间距（CCI），在单侧 2.5mm 关节脱位时成功用于诊断 AOD。我们报告了该技术在 6 例 AOD 患者中的应用。
2 名神经外科医生对 6 例 AOD 患者和 30 例无 AOD 患者的 CT 进行评估。采用以下方法：基底-齿突间距（BDI）、基底-枢轴间距（BAI）、Lee X 线、Powers 比值、CCI 和改良 CCI。研究了每种方法的平均灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）以及kappa 统计量，以表示各方法的组内可靠性。
BDI、BAI、Lee X 线、Power 比值、CCI 和改良 CCI 的平均灵敏度分别为 0.75、0.33、0.67、0.50、1.00 和 1.00。平均特异性均为 1.00。平均 PPV 分别为 1.00、1.00、0.25、1.00、0.80 和 1.00。平均 NPV 分别为 0.96、0.88、0.89、0.91、1.00 和 1.00，kappa 统计量分别为 0.57、0.25、0.25、0.20、1.00 和 1.00。
基于本研究，改良 CCI 方法简单，但对 AOD 的诊断最敏感和可靠。
