Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：创伤性颈椎（c-spine）损伤占所有脊柱损伤的10％。c-脊柱容易受到钝的加速/减速创伤的伤害。加拿大C-Spine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的敏感性和特异性,MRI,X光片,and,第一次,LODOX-Statscan识别钝性创伤和颈部疼痛患者的c-脊柱损伤。
方法：我们使用Inselspital急诊科的患者数据进行了回顾性单中心队列研究，伯尔尼,瑞士最大的一级创伤中心。我们确定了2012年01.01月至2017年12月31日招募期间出现创伤和颈部疼痛的患者。我们纳入了所有需要根据NEXUS标准进行影像学检查的患者。认证的脊柱外科医生检查了每个病例，分析了患者的人口统计学，损伤分类,创伤机制，和应急管理。回顾性完整病例审查被确立为黄金标准，以确定c-脊柱是否受伤。计算CT的敏感性和特异性，MRI,LODOX,和X射线成像方法。
结果：我们确定了4996例患者，其中2321人符合纳入标准。91.3%(n=2120)的患者接受了CT扫描，8.9%(n=206)aMRI,9.3％（n=215）X射线，和21.5%(n=498)的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99%),和89.8％（特异性99.2％）与整形外科医生咨询。MRI的敏感性为88.5%(特异性为96.9%)；突出显示14例MRI正确诊断为损伤，CT误诊。投影射线照相术（灵敏度为36.4%，95.1%特异性)和LODOX(5.3%灵敏度，100％特异性）不适合排除脊髓损伤。
结论：虽然CT对外伤性脊柱损伤的检测具有很高的敏感性，MRI在显示有症状患者的CT未识别的损伤方面具有临床意义。LODOX和投影射线照相术不足以准确排除c脊柱损伤。对于有神经症状的患者，当CT扫描结果为阴性时,我们建议延长使用MRI.
方法：我们使用Inselspital急诊科的患者数据进行了回顾性单中心队列研究，伯尔尼,瑞士最大的一级创伤中心。我们确定了2012年01.01月至2017年12月31日招募期间出现创伤和颈部疼痛的患者。我们纳入了所有需要根据NEXUS标准进行影像学检查的患者。认证的脊柱外科医生检查了每个病例，分析了患者的人口统计学，损伤分类,创伤机制，和应急管理。回顾性完整病例审查被确立为黄金标准，以确定c-脊柱是否受伤。计算CT的敏感性和特异性，MRI,LODOX,和X射线成像方法。
结果：我们确定了4996例患者，其中2321人符合纳入标准。91.3%(n=2120)的患者接受了CT扫描，8.9%(n=206)aMRI,9.3％（n=215）X射线，和21.5%(n=498)的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99%),和89.8％（特异性99.2％）与整形外科医生咨询。MRI的敏感性为88.5%(特异性为96.9%)；突出显示14例MRI正确诊断为损伤，CT误诊。投影射线照相术（灵敏度为36.4%，95.1%特异性)和LODOX(5.3%灵敏度，100％特异性）不适合排除脊髓损伤。
结论：虽然CT对外伤性脊柱损伤的检测具有很高的敏感性，MRI在显示有症状患者的CT未识别的损伤方面具有临床意义。LODOX和投影射线照相术不足以准确排除c脊柱损伤。对于有神经症状的患者，当CT扫描结果为阴性时,我们建议延长使用MRI.
