Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland.
Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland.
Injury. 2023 Jul;54(7):110771. doi: 10.1016/j.injury.2023.05.003. Epub 2023 May 6.
Traumatic cervical spine (c-spine) injuries account for 10% of all spinal injuries. The c-spine is prone to injury by blunt acceleration/deceleration traumas. The Canadian C-Spine rule and NEXUS criteria guide clinical decision-making but lack consensus on imaging modality when necessary. This study aims to evaluate the sensitivity and specificity of CT, MRI, X-Ray, and, for the first time, LODOX-Statscan in identifying c-spine injuries in patients with blunt trauma and neck pain.
We conducted a retrospective monocenter cohort study using patient data from the emergency department at Inselspital, Bern, Switzerland's largest level one trauma center. We identified patients presenting with trauma and neck pain during the recruitment period from 01.01.2012 to 31.12.2017. We included all patients that required a radiographic c-spine evaluation according to the NEXUS criteria. Certified spine surgeons reviewed each case, analyzed patient demographics, injury classification, trauma mechanism, and emergency management. The retrospective full case review was established as gold standard to decide whether the c-spine was injured. Sensitivity and specificity were calculated for CT, MRI, LODOX, and X-Ray imaging methods.
We identified 4996 patients, of which 2321 met the inclusion criteria. 91.3% (n = 2120) patients received a CT scan, 8.9% (n = 206) a MRI, 9.3% (n = 215) an X-ray, and 21.5% (n = 498) a LODOX scan. By retrospective case review, 186 participants were classified as injured. The sensitivity of CT was 88.6% (specificity 99%), and 89.8% (specificity 99.2%) with orthopedic surgeon consultation. MRI had a sensitivity of 88.5% (specificity of 96.9%); highlighting 14 cases correctly diagnosed as injured by MRI and misdiagnosed by CT. Projection radiography (36.4% sensitivity, 95.1% specificity) and LODOX (5.3% sensitivity, 100% specificity) were unsuitable for ruling out spinal injury.
While CT offers high sensitivity for detecting traumatic c-spine injury, MRI holds clinical significance in revealing injuries not recognized by CT in symptomatic patients. LODOX and projection radiography are insufficient for accurately ruling out c-spine injury. For patients with neurological symptoms, we recommend extended MRI use when CT scans are negative.
外伤性颈椎（c 脊柱）损伤占所有脊柱损伤的 10%。c 脊柱容易受到钝性加速/减速创伤的损伤。加拿大 C 脊柱规则和 NEXUS 标准指导临床决策，但在必要时对成像方式缺乏共识。本研究旨在评估 CT、MRI、X 射线和首次使用的 LODOX-Statscan 在识别钝性创伤和颈部疼痛患者的 c 脊柱损伤方面的敏感性和特异性。
我们进行了一项回顾性单中心队列研究，使用瑞士伯尔尼最大一级创伤中心 Inselspital 急诊科的患者数据。我们在 2012 年 1 月 1 日至 2017 年 12 月 31 日期间招募期间识别出出现创伤和颈部疼痛的患者。我们纳入了所有根据 NEXUS 标准需要进行 c 脊柱放射学评估的患者。经过认证的脊柱外科医生对每个病例进行了审查，分析了患者的人口统计学、损伤分类、创伤机制和紧急处理情况。回顾性全病例审查被确立为金标准，以确定 c 脊柱是否受伤。计算了 CT、MRI、LODOX 和 X 射线成像方法的敏感性和特异性。
我们共确定了 4996 名患者，其中 2321 名符合纳入标准。91.3%（n=2120）的患者接受了 CT 扫描，8.9%（n=206）接受了 MRI，9.3%（n=215）接受了 X 射线，21.5%（n=498）接受了 LODOX 扫描。通过回顾性病例回顾，186 名参与者被归类为受伤。CT 的敏感性为 88.6%（特异性为 99%），与骨科医生会诊时的敏感性为 89.8%（特异性为 99.2%）。MRI 的敏感性为 88.5%（特异性为 96.9%）；MRI 正确诊断了 14 例受伤病例，而 CT 则误诊。投影放射摄影术（敏感性 36.4%，特异性 95.1%）和 LODOX（敏感性 5.3%，特异性 100%）不适合排除脊柱损伤。
虽然 CT 对检测外伤性 c 脊柱损伤具有较高的敏感性，但 MRI 在显示症状性患者中 CT 未识别的损伤方面具有临床意义。LODOX 和投影放射摄影术不足以准确排除 c 脊柱损伤。对于有神经症状的患者，当 CT 扫描阴性时，我们建议扩展 MRI 的使用。
