From the St George's University NHS Foundation Trust, London, United Kingdom (Thumbadoo, Herzog, Bhamber, Lupu, Bernard, Bishop, and Lui); the Queen Mary Hospital, Hong Kong, Hong Kong (Kwan); and the Royal Devon and Exeter Hospital, Exeter, United Kingdom (Clarke and Hutton).
J Am Acad Orthop Surg Glob Res Rev. 2022 Oct 21;6(10). doi: 10.5435/JAAOSGlobal-D-22-00067. eCollection 2022 Oct 1.
In the management of a trauma patient with cervical spine injury, the need for accurate diagnostic imaging is key to ensure correct management. Different classification systems have been developed including the Subaxial Injury Classification (SLIC) system and AO cervical spine fracture classification. Through a multicentre study, we have identified a group of cases where the use of CT alone to classify fractures by either SLIC or AO score may be deficient and the use of dynamic cervical spine radiographs could help identify instability.
Three level 1 trauma centers retrospectively reviewed patients with cervical spine injuries. Cervical spine radiographs (AP and lateral) were undertaken in collar, in all patients with suspected cervical spine injury within 2 weeks, followed by reanalysis of scoring systems.
Eleven cases were identified in total, and 72% were male with a mean age of 65 years, with approximately 54% being older than 70 years. All patients reported their pain as severe using the Visual Analogue Scale scale. The predynamic radiograph mean SLIC score was 0.73, which is in contrast to the postdynamic radiograph mean SLIC score of 6. The statistical significance (P = 0.004) was found using the Wilcoxon signed-rank test.
Supine imaging eliminates the gravitational loads normally exerted on the c-spine. The cases show assumed cervical stability based on CT, but dynamic c-spine radiographs subsequently demonstrated instability. Therefore, we suggest a combination of SLIC and AO classification using radiologic imaging to classify fracture and correlate clinical symptoms with persistent neck pain, which warrants a Miami-J collar and dynamic c-spine radiograph to assess stability with re-evaluation of scoring.
在处理颈椎损伤的创伤患者时，准确的诊断影像学至关重要，以确保正确的管理。已经开发了不同的分类系统，包括 Subaxial Injury Classification（SLIC）系统和 AO 颈椎骨折分类。通过一项多中心研究，我们发现一组病例，仅使用 CT 通过 SLIC 或 AO 评分对骨折进行分类可能存在不足，而使用动态颈椎 X 光片可以帮助确定不稳定。
三家一级创伤中心回顾性研究了颈椎损伤患者。在所有疑似颈椎损伤的患者中，均在颈托下进行颈椎前后位和侧位 X 光检查，在 2 周内进行颈椎 X 光检查，然后重新分析评分系统。
总共发现 11 例病例，其中 72%为男性，平均年龄为 65 岁，约 54%的患者年龄大于 70 岁。所有患者均使用视觉模拟量表（VAS）报告其疼痛为严重。动态 X 光片的平均 SLIC 评分与预动态 X 光片的平均 SLIC 评分相比，从 0.73 升高到 6.0，差异有统计学意义（P = 0.004）。
仰卧位成像消除了颈椎通常承受的重力负荷。这些病例基于 CT 显示出假设的颈椎稳定性，但随后的动态颈椎 X 光片显示出不稳定。因此，我们建议使用影像学对 SLIC 和 AO 分类进行组合，以对骨折进行分类，并将临床症状与持续的颈部疼痛相关联，这需要 Miami-J 颈托和动态颈椎 X 光片来评估稳定性，并重新评估评分。
