MDCT was performed on two 64-row scanners (VCT64 and HD750; GE, Milwaukee, WI) using a standard scanning protocol for patients with a suspected C-spine trauma: 120 kV, native helical scan with z-axis dose modulation (10–250 mA) at a noise index of 25 using the thinnest detector collimation available (64 × 0.625 mm). Helliwell et al20 reported in their cross-sectional study that 42% of their normal patient population—without significant complaints or neck pain or history of trauma—revealed a straight alignment of the C-spine in upright CR, and about 33% of these patients showed a cervical kyphosis, also probably reflecting differences in positioning. They concluded that the T1 slope from CR is significantly correlated with the T1 slope from MDCT, and so it may be used as a guide for the assessment of the sagittal balance of the C-spine in MDCT. At C2-C3 and C3-C4 subtle anterolisthesis. Most studies addressing this issue have focused on lordosis measurements using CR imaging for patients without a history of head/neck trauma. Straightening of the cervical spine with loss of physiologic lordosis representing paraspinal muscle stiffness. It was also observed that in both trauma patient groups, straight alignment and segmental kyphosis appeared in 19–21% of the cases, and it was more common at the C5/6 segment. The cervical curve aids in the stabilization of both the head and the spine. The ARA measurements for the patient groups with and without CCI showed predominantly straight alignments (69%) (ARA −13 to +6°) vs lordosis (21%) and kyphosis (10%). As the standard of care for the diagnosis of C-spine trauma is shifting from CR to MDCT, a re-evaluation of normal anatomic alignment is needed. Other authors, such as Grob et al,19 also could not demonstrate a correlation between cervical alignment changes, straightening or kyphosis and neck pain and muscle spasm. Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? The changes are specifically advanced at the c5/6 level and the c5/6 disc space is slightly narrowed. Approximately 2–3% of all trauma patients in emergency departments suffer from cervical spine (C-spine) injury.1 The incidence of C-spine injuries in association with brain injuries among adult trauma patients ranges from 1.7% to 8% and is actually <1% among neurologically intact and alert patients, leading to a large number of normal imaging studies.1–3, The overall sensitivity of conventional radiography (CR) for detecting C-spine injuries is only 39–52% compared with a sensitivity of 90–98% for multidetector CT (MDCT) reported in recent publications, the latter being by far superior to CR. In this group, 35% (n = 6) of the patients revealed a lordotic alignment (mean 22.00; SD 6.39°), 60% of the patients (n = 12) revealed a straight C-spine alignment (mean 5.75; SD 5.01°), and one patient (5%) had a kyphotic alignment (+14°). Statistically, however, the differences were of no significance. Based on prior published data, the following cut-off angle/alignment values were defined to group the patients as follows: lordosis <−13°; straight −13° to +6°; kyphosis >+6°. max., maximum; min., minimum; SD, standard deviation. Possible discrepancies between the readers were resolved by consensus decision. They observed no significant differences between the trauma and non-trauma groups, and they concluded that the coincidental alterations in normal cervical lordosis may not necessarily be related to the trauma itself. no obvious signs of injury to the head, neck and spine; exclusion of skull and vertebral fractures as well as intra- and extra-axial haematoma and ligamentous injuries, which can alter the alignment by itself. Straightening of the C-spine alignment is related to neck positioning and active patient control. Axial T2 Large left posterior paracentral and lateral recess disc extrusion at C5/6 level resulting in indentation of thecal sac and stenosis of the corresponding left neural foramina. The latter is limited as an intraindividual observation. Control group: absolute rotational angle (ARA) C2–7 values (°). If this starts to straighten, curve up, or bows in the opposite direction, cervical kyphosis develops. Patient demographics, age and incidence of degenerative spine disease did not differ from the study group. Axial reconstructions were calculated with a slice thickness of 1.25 mm and a high-resolution bone kernel, 2.5 mm and a soft-tissue kernel, and 0.65 mm for multiplanar reconstructions, applying slice thickness of 2 mm in the coronal and sagittal orientations. These changes in alignment should not be considered primarily pathological or trauma related unless other significant traumatic changes are present. Two experienced, board-certified (7 and 12 years in radiology), independent, blinded readers evaluated all 160 data sets and performed all angle measurements on sagittal multiplanar reconstruction images. In 1975, Weir reviewed 360 asymptomatic patients and found 20 percent to have either straight or reversed cervical curves in … It was also observed that in both trauma patient groups, straight alignment and segmental kyphosis appeared in 19–21% of the cases, and it was more common at the C5/6 segment. A comparison of the CCI+ group vs the CCI− group revealed a slightly smaller number of kyphotic (10% vs 18%, p = 0.34) and lordotic (21% vs 33%, p = 0.33) alignments. The study design was retrospective, and a waiver of consent was granted from the institutional review board. One goes one way, and the adjoining curve goes the opposite way. What Causes the Neck to Straighten? MDCT was performed on two 64-row scanners (VCT64 and HD750; GE, Milwaukee, WI) using a standard scanning protocol for patients with a suspected C-spine trauma: 120 kV, native helical scan with z-axis dose modulation (10–250 mA) at a noise index of 25 using the thinnest detector collimation available (64 × 0.625 mm). CCI, corvical collar immobilization; F, female; M, male; SD, standard deviation. There were no significant differences in age between both patient groups with and without CCI (CCI+ and CCI−). max., maximum; min., minimum; SD, standard deviation. To our knowledge, no study has been performed to date to investigate changes in the C-spine alignment in MDCT imaging of the C-spine after trauma and as to whether CCI significantly influences the values of normal cervical lordosis measurements. There are no published scientific data to date based on supine MDCT C-spine alignment measurements among trauma patients with or without CCI. In the group without CCI (CCI−), 49% (n = 39) had a straight alignment, 18% (n = 14) a kyphotic alignment and 33% (n = 27) a lordotic alignment (Figure 4). The cervical spine usually has a lordotic curvature (posterior concavity) This lordosis may be lost when the neck is held by immobilisation devices - as in this image It was also observed that in both trauma patient groups, straight alignment and segmental kyphosis appeared in 19–21% of the cases, and it was more common at the C5/6 segment. However, in both groups, male patients (61% and 71%) tended to be more involved in traumatic accidents (Table 1). The control group (n = 20), i.e. Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. [In German. A consecutive series of 900 patient files with suspected C-spine trauma were initially extracted from the institutional radiology information system. While traumatic injuries to the neck (e.g. © 2016 The Authors. Cervical spine injury (CSI) is rare in children, accounting for only 1–2% of pediatric trauma. ], CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison, ACR appropriateness criteria on suspected spine trauma, Increasing utilization of computed tomography in the adult emergency department, 2000–2005, National trends in CT use in the emergency department: 1995–2007, Medical radiation exposure in the U.S. in 2006: preliminary results, The Canadian C-spine rule for radiography in alert and stable trauma patients, Neck pain: a long-term follow-up of 205 patients, The curve of the cervical spine: variations and significance, The association between cervical spine curvature and neck pain. This could also increase the number of “straight” C-spine cases among patients with CCI and the difference in C-spine alignment distribution between both trauma patient groups. Table 1. Following the analysis of our non-traumatized control group, we found that even in this group “straight” alignment in supine patients is statistically significantly predominant over lordotic alignment (60% vs 35%, respectively), and even if straight and kyphotic alignments were pooled, there were no statistical differences (control group 65% vs CCI− 67%) to the study group without CCI. Based on prior published data, the following cut-off angle/alignment values were defined to group the patients as follows: lordosis <−13°; straight −13° to +6°; kyphosis >+6°. Loss of lordosis and straightening are often considered to be signs of muscular strain of the C-spine and have served as an indirect sign of cervical trauma or distortion in CR imaging for a long time. Reassessment of the craniocervical junction: normal values on CT, Sagittal plane segmental motion of the cervical spine. Roentgenographic variations in the normal cervical spine, Sagittal alignment of the cervical spine after neck injury, Roentgenographic signs of cervical injury, Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis, Relationship between alignment of upper and lower cervical spine in asymptomatic individuals, Correlation of cervical lordosis measurement with incidence of motor vehicle accidents. A, Lateral view, radiographic examination of the cervical spine.Best visualizes fractures and dislocations. Otherwise unremarkable cervical spine MRI. The condition describes a spinal state in which the normal lumbar or cervical region is reduced in its degree of front to back curvature, also medically known as hypolordosis. Published by the British Institute of Radiology, Institute for Diagnostic and Interventional Radiology, HELIOS Clinic München West & München Perlach, Munich, Germany, Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany, Department of Radiology, University of Latvia, Riga, Latvia, Department of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy, European Society of Emergency Radiology (ESER), Vienna, Austria, 160 consecutive patients after C-spine trauma admitted to a Level 1 trauma centre received MDCT according to Canadian Cervical Spine Rule and National Emergency X-Radiography Utilization Study indication rule; subgroups with and without cervical collar immobilization (CCI +/−) were compared with a control group (, In the two CCI−/CCI+ study groups, the straight or kyphotic alignment significantly (. When the curve points toward the front, it’s called a lordosis and toward the back, it’s called a kyphosis. In both trauma patient groups, but mainly among patients with CCI+, it was also noted that sharp segmental lordosis was mostly visualized because of negative (lordotic) angulation for the C2/3 or C6/7 segments in otherwise generally straight C-spine alignments (, Incidence of cervical spine injuries in association with blunt head trauma, Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics, Clinical characterization of comatose patients with cervical spine injury and traumatic brain injury, Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis, Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS), Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma, Roentgenographic findings of the cervical spine in asymptomatic people, Polytrauma: optimal imaging and evaluation algorithm, Importance of multidetector CT imaging in multiple trauma. Control group: absolute rotational angle (ARA) C2–7 values (°). The number of patients with straight C-spine alignment was higher in the CCI+ group (CCI+ 69% vs CCI− 49%, p = 0.05). [In German. Straightening of the C-spine alone is not a definitive sign of injury but is a biomechanical variation due to CCI and neck positioning during MDCT or active patient control. The SEM for the PTM Harrison (1° < SEM < 2°) is lower than the reported values for the Cobb method (3° < SEM < 10°), and it is considered to be both more reliable and reproducible. Approximately 2–3% of all trauma patients in emergency departments suffer from cervical spine (C-spine) injury. 160 consecutive patients after C-spine trauma admitted to a Level 1 trauma centre received MDCT according to Canadian Cervical Spine Rule and National Emergency X-Radiography Utilization Study indication rule; subgroups with and without cervical collar immobilization (CCI +/−) were compared with a control group (n = 20) of non-traumatized patients. From this pool, 160 continuous MDCT examinations (study group) that met the following criteria were considered for the study:need for diagnostic imaging after head and/or neck trauma according to established clinical decision rules—the National Emergency X-Radiography Utilization Study and CCR—which were in use at our Level 1 trauma centreMDCT imaging performed on a 64-row MDCT scanner using a standard C-spine protocol within 1 h after admissionpatient age: 18–50 years. The control group revealed no significant differences. This could also increase the number of “straight” C-spine cases among patients with CCI and the difference in C-spine alignment distribution between both trauma patient groups. Straightening of the C-spine alone is not a definitive sign of injury but is a biomechanical variation due to CCI and neck positioning during MDCT or active patient control. In the group with CCI (CCI+), there was a significantly higher number of patients with a straight C-spine alignment (69% vs 49%, p = 0.05). MDCT is becoming increasingly important for C-spine trauma imaging for adults. Following today's established clinical indication guidelines such as the National Emergency X-Radiography Utilization Study (NEXUS) and Canadian Cervical Spine Rule (CCR), which are based on comprehensive prospective multicentre studies; CR imaging can be used instead of CT only for neurologically intact and alert patients, who are considered low risk. No evidence of abnormal post contrast enhancement noted in the lesion. Student's t-test was used to determine the statistical significance of angle values between the two groups and for each subtype of cervical alignment (IBM Corp., New York, NY; formerly SPSS® Inc., Chicago, IL). The interpretation of cervical spine images can be challenging even for the most experienced radiologist. These patients were classified according to defined ARA values as “lordotic”, although upon subjective visual assessment, they could be classified as “straight”. MRI of cervical spine revealed altered signal intensity of C5 vertebral body in the form of T2/STIR hyperintensity and T1 hypointensity suggestive of marrow oedema [Fig. Emergency radiology: straightening of the cervical spine in MDCT after trauma—a sign of injury or normal variant. Most studies addressing this issue have focused on lordosis measurements using CR imaging for patients without a history of head/neck trauma. Concerning interobserver variability, none of the recorded differences between angle values observed by the two independent readers proved to be statistically significant (p ≥ 0.05). A cut-off age of 50 years was imposed to exclude age-dependent degenerative changes of the C-spine, which can impair the normal alignment before trauma. Two experienced, board-certified (7 and 12 years in radiology), independent, blinded readers evaluated all 160 data sets and performed all angle measurements on sagittal multiplanar reconstruction images. Following the analysis of our non-traumatized control group, we found that even in this group “straight” alignment in supine patients is statistically significantly predominant over lordotic alignment (60% vs 35%, respectively), and even if straight and kyphotic alignments were pooled, there were no statistical differences (control group 65% vs CCI− 67%) to the study group without CCI. More study is needed to characterize the specific dynamics and etiologies involved in the determination of cervical spine configuration. Straightening of the C-spine alignment in MDCT alone is not a definitive sign of injury. Concerning interobserver variability, none of the recorded differences between angle values observed by the two independent readers proved to be statistically significant (, There were no significant differences in age between both patient groups with and without CCI (CCI+ and CCI−). Straightening of the C-spine alignment is related to neck positioning and active patient control. Follow these hacks each day to improve, protect, and straighten your spine. In both trauma patient groups, but mainly among patients with CCI+, it was also noted that sharp segmental lordosis was mostly visualized because of negative (lordotic) angulation for the C2/3 or C6/7 segments in otherwise generally straight C-spine alignments (, Incidence of cervical spine injuries in association with blunt head trauma, Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics, Clinical characterization of comatose patients with cervical spine injury and traumatic brain injury, Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis, Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS), Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma, Roentgenographic findings of the cervical spine in asymptomatic people, Polytrauma: optimal imaging and evaluation algorithm, Importance of multidetector CT imaging in multiple trauma. 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