The diagnostic precision of computed tomography for traumatic cervical spine injury: An in vitro biomechanical investigation.

Jan 17, 2022

Contributor: Shun Yamamoto,Tom Whyte,Carolyn Van Toen,Angela Melnyk,Jason Shewchuk,John Street,Peter Cripton,Thomas R Oxland

CT is considered the best method for vertebral fracture detection clinically, but its efficacy in laboratory studies is unknown. Therefore, our objective was to determine the sensitivity, precision, and specificity of high-resolution CT imaging compared to detailed anatomic dissection in an axial compression and lateral bending cervical spine biomechanical injury model.
35 three-vertebra human cadaver cervical spine specimens were impacted in dynamic axial compression (0.5 m/s) at one of three lateral eccentricities (low 5% of the spine transverse diameter, middle 50%, high 150%) and two end conditions (19 constrained lateral translation and 16 unconstrained). All specimens were imaged using high resolution CT imaging (246 μm). Two clinicians (spine surgeon and neuroradiologist) diagnosed the vertebral fractures based on 34 discrete anatomical structures using both the CT images and anatomical dissection.
The sensitivity of CT was highest for fractures of the facet joint (59%) and vertebral endplate (57%), and was lowest for pedicle (13%) and lateral mass fractures (23%). The precision of CT was highest for spinous process fractures (83%) and lowest for pedicle (21%), uncinate process and lateral mass (both 23%) fractures. The specificity of CT exceeded 90% for all fractures. The Kappa value between the two reviewers was 0.52, indicating moderate agreement.
In this in vitro cervical spine injury model, high resolution CT scanning missed many fractures, notably those of the lateral mass and pedicle. This finding is potentially important clinically, as the integrity of these structures is important to clinical stability and surgical fixation planning.

Copyright © 2021 Elsevier Ltd. All rights reserved.

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About The Expert

Shun Yamamoto

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada; Department of Orthopaedic Surgery, Jikei University Graduate School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.

Tom Whyte

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.

Carolyn Van Toen

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.

Angela Melnyk

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.

Jason Shewchuk

Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W. 12(th) Ave., Vancouver, BC V5Z 1M9, Canada.

John Street

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.

Peter Cripton

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.

Thomas R Oxland

Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada. Electronic address: toxland@mail.ubc.ca.

References

PubMed