Emergency radiology: straightening of the cervical spine in MDCT after trauma a sign of injury or normal variant?
OBJECTIVE To evaluate whether straightening of the cervical spine (C spine) alignment after trauma can be considered a significant multidetector CT (MDCT) finding. METHODS 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. Two independent readers evaluated retrospectively the alignment, determined the absolute rotational angle of the posterior surface of C2 and C7 (ARA C2 7) and grouped the results for lordosis 13deg) straight 13 to +6deg) and kyphosis +6deg) RESULTS In the two CCI /CCI+ study groups, the straight or kyphotic alignment significantly (p 0.001) predominated over lordosis. The number of patients with straight C spine alignment was higher in the CCI+ group (CCI+ 69% vs CCI 49% p 0.05) 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. Statistically, however, the differences were of no significance. The control group revealed no significant differences. CONCLUSION 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. ADVANCES IN KNOWLEDGE Straightening of the C spine alignment in MDCT alone is not a definitive sign of injury. Straightening of the C spine alignment is related to neck positioning and active patient control. CCI has a straightening effect on the cervical alignment.
The British journal of radiology