ABSTRACT: Radiographic measurement study.
To assess the interobserver reliability of radiographic measurements for subaxial cervical spine trauma; to compare the reliability of measurements made on computed tomography (CT) versus those made using plain radiographs.
Despite the importance of imaging and classification of subaxial cervical injuries, the persistent lack of a uniform measurement protocol remains an obstacle. Recently, the Spine Trauma Study Group published a proposal for a standardized set of measurement techniques for the radiographic evaluation of subaxial cervical spine trauma. While a worthwhile venture, the observer error of these methods was not tested.
Lateral cervical plain radiographs and CT images of 30 patients who sustained a broad spectrum of subaxial cervical spine injuries were distributed to surgeons. Participants were asked to measure kyphosis, translation, vertebral body height loss, and facet joint apposition. Each rater was provided with a pictorial diagram illustrating the prescribed measurement technique. All measurements were made using plain radiographs and CT images with the exception of facet joint apposition, which was assessed using only CT. Reliability was examined by calculating the ICC and Pearson correlation coefficients. RESULTS.: Vertebral body translation was the most reproducible method on both CT images and plain radiographs. Kyphosis measurements were less reproducible, though the endplate method demonstrated superior reliability to the posterior tangent method. Plain radiographic measurement of anterior vertebral body height loss demonstrated moderate reliability while all other height loss measurements were found to show poor reliability. Facet joint apposition measurement demonstrated poor reproducibility.
Despite a consensus regarding their importance in directing treatment, radiographic measurements for subaxial cervical spine trauma demonstrate inconsistent reliability. Even in the idealized setting used in this investigation, there was limited agreement between observers. Although translation and kyphosis showed satisfactory reproducibility, results for vertebral body height loss and facet joint apposition were unreliable. On the basis of these findings, it may be more appropriate to describe facet joint apposition binomially as "present" or "not present" instead of a numerical value; vertebral body height loss may be more appropriately characterized in quaternary terms, such as less than 25%, 25% to 50%, 50% to 75%, and more than 75%. Though simpler, such descriptions would need to be validated in future studies.
Spine 05/2011; 36(17):1374-9. · 2.08 Impact Factor
ABSTRACT: Diagnosis of cervical facet dislocation is difficult when relying on plain radiographs alone. This study evaluates the interobserver reliability of helical computed tomography (CT) in the assessment of cervical translational injuries, correlates the radiographic diagnosis with intraoperative observation, and examines the role of neurologic injury in the evaluation and diagnosis of these injuries.
Clinical histories and radiographic studies of 10 patients with cervical facet dislocations were presented to 25 surgeons. Participants classified cases as unilateral or bilateral facet dislocations after reviewing selected axial CT slices and sagittal reconstructions. Surgeons' interpretations were compared with intraoperative diagnosis. Participants interpreted the same radiographic studies with 3 different clinical scenarios: neurologically intact, incomplete, and complete spinal cord injury. Vertebral body translation from midsagittal CT was evaluated to confirm whether all unilateral facet dislocations had <25% translation.
Interrater kappa coefficient showed moderate agreement between observers in classifying injuries as unilateral or bilateral (kappa: 0.54-0.58), regardless of neurologic status. Percent agreement among observers varied from 50% to 100% for each individual case. Agreement was statistically higher for bilateral facet dislocation (85%) than for unilateral dislocations (78%), with 1 unilateral fracture showing nearly 50% translation on a midsagittal image.
The addition of helical CT to reconstruction enables spine surgeons to more reliably distinguish bilateral from unilateral cervical facet dislocations. Despite frequent occurrence of these injuries and presumed agreement on injury description, agreement may be improved by a more precise definition of facet dislocations and subluxations and thorough review of all imaging studies.
The journal of spinal cord medicine 01/2009; 32(1):43-8. · 2.11 Impact Factor
ABSTRACT: Postoperative spinal wound infections occur in 1 to 12% of patients. The rate of infection is related to the type and duration of the procedure, comorbidities, nutritional status, and various other risk factors. Antibiotic prophylactic therapy has been clearly shown to decrease the rate of infection dramatically after lumbar surgery. These infections typically manifest with signs and symptoms of wound swelling, erythema, and drainage. Laboratory-detected values such as the erythrocyte sedimentation rate and C-reactive protein can be elevated beyond what is normal for the uncomplicated postoperative course following lumbar surgery, and combined with the clinical symptoms should alert the physician to the possibility of infection. When detected, these infections should be managed aggressively with operative debridment and irrigation, including the deep subfascial layer in all cases except those with clearly demarcated superficial infection. The choice of one versus multiple debridments can be made based on the appearance of the wound, patient factors, and nutritional status. Hardware and incorporated bone graft can be left in place in the majority of cases, adding to stability. Outcomes following aggressive treatment of this complication can be excellent, with no long-term loss of function and complete eradication of the infection.
Neurosurgical FOCUS 10/2003; 15(3):E14. · 2.87 Impact Factor