Session VI - Spine

Fri., 10/6/06 Pediatrics & Spine, Paper #32, 11:56 am

Evaluating the Effectiveness of Helical CT Scan for Cervical Spine Injuries

Paul Appleton, MD (n); Mark Vrahas, MD (n); Laurie Petrovick, MHSA (n);
Massachusetts General Hospital, Boston, Massachusetts, USA

Purpose: Helical CT is being increasingly used in acute trauma patients as an initial screening tool for identifying cervical spine injuries. There is concern that the CT scan may not identify ligamentous injuries that can be especially difficult to evaluate in the unconscious or multiply injured patient. Current CT scanning technology has afforded the opportunity to visualize the cervical spine in accurate three-dimensional reconstructed images. It is possible that with current technology, soft-tissue injuries about the cervical spine such as swelling and minor avulsions should be recognized. The purpose of this study is to determine the accuracy of cervical CT in identifying injuries, both bony and ligamentous, in the trauma patient and to determine if any injuries were missed by CT scan.

Methods: A retrospective review was undertaken of trauma patients admitted to a level I trauma center between January and August 2002. Over an 8-month period, 1203 trauma patients were seen in the emergency department. The average ISS was 14. Cervical CT scans were obtained in 577 patients (48%). All patients with a reportedly normal CT scan were identified and their medical records reviewed to determine if a patient ultimately had an injury that was not picked up by the initial CT scan.

Results: 68 fractures were identified on CT scan. Eight patients had normal CT scans but neurologic symptoms on examination and were eventually found to have spinal cord injury diagnosed by MRI (acute disk or central cord syndrome). Of the remaining 501 CT scans that were interpreted as normal, no patients were subsequently found to have a cervical spine injury that was initially missed.

Conclusion/Significance: Current technology involving helical CT scan continues to improve. It is now possible to obtain three-dimensional images of the cervical spine quickly and with very accurate detail. This study shows that no ligamentous cervical spine injuries were missed through the use of helical CT. Continued improvement in technology may make CT scanning accurate enough to rule out cervical spine injury and eliminate the need for flexion/extension films or other methods of excluding soft-tissue injury about the cervical spine.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.