Imaging of Spine Trauma

Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma.

A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology.

744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity.

Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma.

Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.

The first seven vertebrae of our spine are called the cervical spine. It supports the weight of our head, encloses and safeguards our spinal cord, and permits a variety of head motions. The seven cervical vertebrae are joined at the rear of the bone by a kind of joint known as a facet joint. These joints enable us to move our necks forward, backward, and twist. Fractures of the cervical spine are a medical emergency that may lead to lifelong paralysis or even death. If left untreated and undetected, these fractures can worsen over time. Using computed tomography, a cervical spine fracture in individuals can be accurately diagnosed. Given the scarcity of research on the practical use of deep learning methods in detecting spine fractures in persons, it is imperative to address this gap. This study uses a dataset containing fracture and normal cervical spine computed tomography images. This study proposed modified transfer-learning-based MobileNetV2, InceptionV3, and Resnet50V2 models. An ablation study was also conducted to determine the optimal custom layers for models and data augmentation techniques. In addition, evaluation metrics have been used to analyze and compare the model's performance. Among all the approaches, MobileNetV2 with augmentation has achieved the highest accuracy of 99.75%. Furthermore, the best-performing model has been deployed in a smartphone-based Android application.

Las consecuencias de un traumatismo de la columna cervical pueden variar desde lesiones menores estables hasta lesiones complejas e inestables con posibles secuelas neurológicas o afectación vascular.

Los criterios canadienses (Canadian C-Spine Rule) y los criterios NEXUS tratan de identificar a aquellos individuos con bajo riesgo de presentar lesiones por traumatismo cervical y en quienes se puede prescindir con seguridad de la exploración radiológica. En pacientes con alto riesgo, está indicada una prueba de imagen, siendo la técnica de elección, en adultos, la tomografía computarizada multidectector. En ocasiones son necesarios estudios complementarios como una angio-TC de troncos supraaórticos o una resonancia magnética.

Diagnosticar y clasificar estas lesiones pueden ser un desafío para el radiólogo, ya que algunas de ellas pueden ser sutiles y difíciles de detectar. Este trabajo tiene como objetivo describir los hallazgos radiológicos más relevantes y las clasificaciones más utilizadas.

Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular involvement.

The Canadian C-Spine Rule and the NEXUS criteria aim to identify individuals with a low risk of cervical spine trauma who can safely forgo imaging tests. In high-risk patients, an imaging test is indicated. In adult patients the imaging test of choice is multidetector computed tomography. Complementary imaging tests such as CT angiography of the supra-aortic vessels and/or magnetic resonance imaging are occasionally necessary.

It can be challenging for radiologists to diagnose and classify these lesions, because some of them can be subtle and difficult to detect. This paper aims to describe the most important imaging findings and the most widely used classification systems.

Approximately 3-4% of blunt trauma patients sustain fractures to the spinal column/axial skeleton. Most of these injuries result from high impact blunt forces secondary to motor vehicular collisions and accidental falls. Blunt force injuries can significantly disrupt the axial skeleton. The clinical presentation of these injuries can range from minimally symptomatic to injuries that present with partial neurological deficits or complete spinal cord injuries and transection with resultant paralysis manifesting as paraplegia or even quadriplegia. Penetrating injuries are usually the cause of gunshots, rarely knives and in military arenas of warfare as the results of automatic weapons, land mines or improvised explosive devices (IEDs). This chapter covers in great detail the clinical presentation as well as the necessary imaging required to diagnose these injuries.

Spine trauma is an ominous event with a high morbidity, frequent mortality, and significant psychological, social, and financial consequences for patients, their relatives and society. On average three out of four spinal fractures involve the thoracolumbar spine and up to one-third are complicated by spinal cord injury. Spinal cord injuries (SCI) are a significant cause of disability in US and in all western countries. Knowledge of the main principles of biomechanics is essential in understanding the patho-morphology of spinal injuries, and the evolution of the various classification systems. Classification systems should be able to create a common language between specialists in order to improve patients’ prognosis, guide treatment and compare treatment outcomes. Imaging has always been crucial in the evaluation of the injury type and accompanied the development of different classification systems. Thoracolumbar spine (TLS) trauma has a wide spectrum ranging from minor isolated fractures to highly unstable fracture-dislocations. Early classification systems were based on the analysis of the pattern of bony injuries on radiographs and CT. Traditionally, conventional radiographs are performed to confirm the clinical suspicion and to depict the level and type of bone injury. However, because of their inherent limitations, radiographs are often more helpful in proving the existence of a suspected bony spinal injury rather than excluding it. Multidetector computed tomography (MDCT) is superior in evaluating bone anatomy and, especially in polytrauma patients, it is the first line imaging modality. Morphological bone damage may be accurately shown and classified on CT. the most recent classifications also incorporate the integrity of soft tissues structures, which is considered equally relevant to spinal stability. Injuries to ligaments and discs can only be suspected on radiographs and conventional CT, although dual-energy CT is offering new insights on collagen mapping of damaged discs. Magnetic resonance imaging (MRI) may directly assess disc and ligamentous injuries, but also subtle osseous injuries, playing a complementary role in defining the whole spinal damage and an eventual instability. MRI is the only valid modality to assess the spinal cord (SC) and is indicated whenever a neurologic injury is suspected. Advanced MRI techniques, such as diffusion weighted imaging (DWI) and tractography, may provide further information regarding the integrity of the white matter which may improve outcome prognostication. Despite challenges in terms of costs, availability, accessibility and specificity, MRI and advanced MRI techniques are increasingly being used in spinal injuries. We present a review on TLS traumas discussing on the development of different classification system used in their evaluation, the role of imaging for their detection and the correlation to the patients’ outcomes and treatment options.

Lumbosacral spinal pathologies are not uncommon and include trauma, malignancy, infection, and degenerative disease. The primary diagnostic imaging modalities used to evaluate the lumbosacral spine include plain-film radiographs, magnetic resonance imaging, and computed tomography (CT).Compared to plain radiography and magnetic resonance imaging (MRI), CT provides ultrafine spatial anatomic detail that allows for optimal evaluation of bony anatomy and pathology. Furthermore, image reformatting and three-dimensional reconstructions allow the surgeon to better visualize spinal anatomy in the setting of difficult to visualize regions of the axial skeleton (e.g., sacrum) and when evaluating complex pathologies (e.g., severe spinal deformities, high-grade spondylolistheses, complex fractures, and neoplasms). Importantly, in the setting of neural compression, CT allows for better distinction between compression secondary to soft tissue versus bony pathology. In patients with contraindications to MRI (the presence of certain pacemakers or defibrillators), CT myelogram is a useful surrogate to assess for soft tissue pathology. In this chapter, the specific benefits and disadvantages of CT compared to other imaging modalities are highlighted in detail.