Servikal Omurga Yaralanmalarında Tanı Görüntüleme Yöntemleri

Son yıllarda servikal omurga yaralanmalı hastaların radyolojik değerlendirilmelerinde genel düşünce ve pratik değişmektedir. Radyolojik incelemelerin artmasına paralel olarak tıbbi maliyetlerin ve hastaların maruz kaldıkları radyasyonun artmasıyla ilişkili olarak radyografinin gerekliliği, bunun yanı sıra bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG)’nin yeri ve önemi sorgulanmaktadır. Bu yazıda boyun travmalı hastalarda radyolojik incelemede izlenmesi gereken yol hakkında bir rehber oluşturulmaya çalışılmıştır

Diagnostic Imaging of Cervical Spine Injuries

In recent years, the general concepts about radiological evaluation of patients with traumatic cervical vertebra injuries have changed. The indications of magnetic resonance imaging, computerized tomography or even the necessity of radiography with the increased medical costs and exposed radiation are being discussed. In the presented study, we aimed to determine a guide for radiological examination in patients with neck trauma

___

  • Bayless P, Ray VG: Incidence of cervical spine injuries in association with blunt head trauma. Am J Emerg Med. 7:139-142, 1989.
  • Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 343: 94-99, 2000.
  • Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M: Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study.Ann Emerg Med 21: 1454-1460, 1992.
  • Hoffman JR, Wolfson AB, Todd K, Mower WR: Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X- Radiography Utilization Study (NEXUS). Ann Emerg Med. 32: 461-469. 1998.
  • Kreipke DL, Gillespie KR, McCarthy MC, Mail JT, Lappas JC, Broadie TA: Reliability of indications for cervical spine films in trauma patients. J Trauma. 29:1438-1439, 1989.
  • Neifeld GL, Keene JG, Hevesy G, Leikin J, Proust A, Thisted RA: Cervical injury in head trauma. J Emerg Med. 6:203-207, 1988.
  • Roberge RJ, Wears RC, Kelly M, Evans TC, Kenny MA, Daffner RD, Kremen R, Murray K, Cottington EC: Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma. 28:784-788, 1988.
  • Ringenberg BJ, Fisher AK, Urdaneta LF, Midthun MA: Rational ordering of cervical spine radiographs following trauma. Ann Emerg Med. 17:792-796, 1988.
  • McNamara RM, Heine E, Esposito B: Cervical spine injury and radiography in alert, high-risk patients. J Emerg Med. 8:177-182. 1990.
  • Mirvis SE, Diaconis JN, Chirico PA, Reiner BI, Joslyn JN, Militello P: Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study.Radiology. 170:831-834, 1989.
  • Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M: Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 21:1454-1460, 1992.
  • Kreipke DL, Gillespie KR, McCarthy MC, Mail JT, Lappas JC, Broadie TA: Reliability of indications for cervical spine films in trauma patients. J Trauma. 29:1438-1439, 1989.
  • Chapman M: Upper cervical spine injuries, in Rockwood and Gren: Fractures in Adults, (ed 4), Philadelphia, PA. Lippincott, Williams&Wilkins, 2001, ch.32.
  • Lindsey RW, Diliberti TC, Doherty BJ, Watson AB: Efficacy of radiographic evaluation of the cervical spine in emergency situations. South Med J. 86:1253-1255, 1993
  • Davis JW, Phreaner DL, Hoyt DB, Mackersie RC: The etiology of missed cervical spine injuries. J Trauma. 34:342-346, 1993.
  • Ross SE, O'Malley KF, DeLong WG, Born CT, Schwab CW: Clinical predictors of unstable cervical spinal injury in multiply injured patients. Injury. 23: 317-319, 1992
  • Roth BJ, Martin RR, Foley K, Barcia PJ, Kennedy P: Roentgenographic evaluation of the cervical spine. A selective approach. Arch Surg. Jun;129: 643-645, 1994.
  • Dodd FM, Simon E, McKeown D, Patrick MR: The effect of a cervical collar on the tidal volume of anaesthetised adult patients. Anaesthesia. 50:961- 963, 1995.
  • Liew SC, Hill DA: Complication of hard cervical collars in multi-trauma patients. Aust N Z J Surg. 64(2):139-140, 1994.
  • Raphael JH, Chotai R: Effects of the cervical collar on cerebrospinal fluid pressure. Anaesthesia. May;49: 437-439, 1994.
  • Gerrelts BD, Petersen EU, Mabry J, Petersen SR: Delayed diagnosis of cervical spine injuries. J Trauma. 31:1622-1626, 1991.
  • Reid DC, Henderson R, Saboe L, Miller JD: Etiology and clinical course of missed spine fractures. J Trauma. 27: 980-986, 1987.
  • Ajani AE, Cooper DJ, Scheinkestel CD, Laidlaw J, Tuxen DV: Optimal assessment of cervical spine trauma in critically ill patients: a prospective evaluation. Anaesth Intensive Care. 26: 487-491, 1998.
  • Berne JD, Velmahos GC, El-Tawil Q, Demetriades D, Asensio JA, Murray JA, Cornwell EE, Belzberg H, Berne TV: Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. J Trauma. 47: 896-902, 1999.
  • Borock EC, Gabram SG, Jacobs LM, Murphy MA: A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma. 31:1001-1005, 1991.
  • Davis JW, Parks SN, Detlefs CL, Williams GG, Williams JL, Smith RW: Clearing the cervical spine in obtunded patients: the use of dynamic fluoroscopy. J Trauma. 39: 435-438, 1995.
  • Freemyer B, Knopp R, Piche J, Wales L, Williams J: Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. Ann Emerg Med. Aug;18:818-821, 1989.
  • Lewis LM, Docherty M, Ruoff BE, Fortney JP, Keltner RA Jr, Britton P: Flexion-extension views in the evaluation of cervical-spine injuries. Ann Emerg Med. 20:117-121, 1991.
  • MacDonald RL, Schwartz ML, Mirich D, Sharkey PW, Nelson WR: Diagnosis of cervical spine injury in motor vehicle crash victims: how many X-rays are enough? J Trauma. 30:392-397. 1990.
  • Ireland AJ, Britton I, Forrester AW: Do supine oblique views provide better imaging of the cervicothoracic junction than swimmer's views? J Accid Emerg Med. 15:151-154, 1998.
  • Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa MC: Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury.J Neurosurg. 85: 824-829, 1996.
  • D'Alise MD, Benzel EC, Hart BL: Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient. J Neurosurg. 91(1 Suppl):54-59, 1999.
  • Emery SE, Pathria MN, Wilber RG, Masaryk T, Bohlman HH: Magnetic resonance imaging of posttraumatic spinal ligament injury. J Spinal Disord. 2: 229-233, 1989.
  • Katzberg RW, Benedetti PF, Drake CM, Ivanovic M, Levine RA, Beatty CS, Nemzek WR, McFall RA, Ontell FK, Bishop DM, Poirier VC, Chong BW: Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology. 213: 203-212, 1999.
  • White P, Seymour R, Powell N: MRI assessment of the pre-vertebral soft tissues in acute cervical spine trauma. Br J Radiol. 72: 818-823, 1999.
  • Klein GR, Vaccaro AR, Albert TJ, Schweitzer M, Deely D, Karasick D, Cotler JM
  • Efficacy of magnetic resonance imaging in the evaluation of posterior cervical spine fractures. Spine. 24: 771-774. 1999.
  • Banit DM, Grau G, Fisher JR: Evaluation of the acute cervical spine: a management algorithm. J Trauma. 49:450-456, 2000.
  • Brady WJ, Moghtader J, Cutcher D, Exline C, Young J: ED use of flexion-extension cervical spine radiography in the evaluation of blunt trauma. Am J Emerg Med. 17:504-508, 1999.
  • Brohi K, Wilson-Macdonald J. Evaluation of unstable cervical spine injury: a 6-year experience. J Trauma. 2000 Jul;49(1):76-80.
  • Kirshenbaum KJ, Nadimpalli SR, Fantus R, Cavallino RP: Unsuspected upper cervical spine fractures associated with significant head trauma: role of CT. J Emerg Med. 8:183-198. 1990.
  • Jonsson H Jr, Bring G, Rauschning W, Sahlstedt B: Hidden cervical spine injuries in traffic accident victims with skull fractures. J Spinal Disord. 4:251- 263. 1991.
  • Haug RH, Prather JL: The closed reduction of nasal fractures: an evaluation of two techniques. J Oral Maxillofac Surg. 49:1288-1292, 1991.
  • Vandemark RM: Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR Am J Roentgenol.155: 465- 472, 1990
  • American Collage of Radiology Appropriateness Criteria for Imaging and Treatment Desicions. Reston, VA, American Collage of Radiology, ms 2.1-2.8,1995.
  • Naidich JB, Naidich TP, Garfein C, Liebeskind AL, Hyman RA: The widened interspinous distance: a useful sign of anterior cervical dislocation in the supine frontal projection. Radiology. Apr;123:113- 116, 1977.
  • Roberge RJ: Facilitating cervical spine radiography in blunt trauma. Emerg Med Clin North Am. 9:733- 742, 1991.
  • Lewis LM, Docherty M, Ruoff BE, Fortney JP, Keltner RA Jr, Britton P: Flexion-extension views in the evaluation of cervical-spine injuries. Ann Emerg Med. 20:117-121, 1991.
  • Wackenheim A: Roentgen diagnosis of the craniovertebral region (ed1), New York, NY, Springer-Verlag 1974.
  • Harris JH Jr, Carson GC, Wagner LK, Kerr N: Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 162:887-892, 1994
  • Spence KF Jr, Decker S, Sell KW: Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am. 52:543-549, 1970.
  • Oda T, Panjabi MM, Crisco JJ 3rd, Oxland TR, Katz L, Nolte LP: Experimental study of atlas injuries. II. Relevance to clinical diagnosis and treatment. Spine. 16: S466-473, 1991.
  • Berquist TH: Imaging of adult cervical spine trauma. Radiographics. 8:667-694, 1988.
  • Swischuk LE, Swischuk PN, John SD: Wedging of C-3 in infants and children: usually a normal finding and not a fracture. Radiology. 188: 523-526, 1993.
  • Daffner RH, Deeb ZL, Rothfus WE: Pseudofractures of the cervical vertebral body. Skeletal Radiol. 15: 295-298,1986.
  • Regenbogen VS, Rogers LF, Atlas SW, Kim KS: Cervical spinal cord injuries in patients with cervical spondylosis. AJR Am J Roentgenol. 146: 277-284,1986.
  • Penning L: Prevertebral hematoma in cervical spine injury: incidence and etiologic significance. AJR Am J Roentgenol. 136: 553-561, 1981.
  • Paakkala T: Prevertebral soft tissue changes in cervical spine injury. Crit Rev Diagn Imaging. 24: 201-236, 1985.
  • Wholey MH, Bruwer AJ, Baker HL Jr: The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology. 71: 350-356, 1958.
  • Sistrom CL, Southall EP, Peddada SD, Shaffer HA Jr: Factors affecting the thickness of the cervical prevertebral soft tissues. Skeletal Radiol 22:167-171, 1993.
  • Miles KA, Finlay D: Is prevertebral soft tissue swelling a useful sign in injury of the cervical spine? Injury. 19:177-179,1988.
  • Silberstein M, Tress BM, Hennessy O: Prevertebral swelling in cervical spine injury: identification of ligament injury with magnetic resonance imaging. Clin Radiol. 46:318-323, 1992.
  • Suss RA, Zimmerman RD, Leeds NE: Pseudospread of the atlas: false sign of Jefferson fracture in young children. AJR Am J Roentgenol. 140:1079-1082,1983.
  • Kaye JJ, Nance EP Jr: Cervical spine trauma. Orthop Clin North Am. 21:449-462,1990.
  • Woodring JH, Lee C: The role and limitations of computed tomographic scanning in the evaluation of cervical trauma. J Trauma. 33: 698-708, 1992.
  • Woodring JH, Lee C: Limitations of cervical radiography in the evaluation of acute cervical trauma. J Trauma. 34: 32-9, 1993.
  • Pech P, Kilgore DP, Pojunas KW, Haughton VM: Cervical spinal fractures: CT detection. Radiology. 157:117-120, 1985.
  • Hall AJ, Wagle VG, Raycroft J, Goldman RL, Butler AR: Magnetic resonance imaging in cervical spine trauma. J Trauma. 34: 21-26, 1993.
  • Davidoff G, Roth E, Morris J, Bleiberg J, Meyer PR Jr: Assessment of closed head injury in trauma-related spinal cord injury. Paraplegia. 24: 97-104, 1986.
  • Bundschuh CV, Alley JB, Ross M, Porter IS, Gudeman SK: Magnetic resonance imaging of suspected atlanto- occipital dislocation. Two case reports. Spine. 17:245- 248, 1992.
  • Katzberg RW, Benedetti PF, Drake CM, Ivanovic M, Levine RA, Beatty CS, Nemzek WR, McFall RA, Ontell FK, Bishop DM, Poirier VC, Chong BW: Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology. 213: 203-212, 1999.