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1、TaylorLloyd,HMS3GillianLieberman,MDCervicalSpineTraumaandRelevantImagingModalitiesTaylorLloyd,HarvardMedicalSchoolIIIDr.GillianLieberman,MDNovember2011TaylorLloyd,HMS3GillianLieberman,MDOutline•CasePresentation•MechanismsofInjury•DifferentialDiagnoses•ImagingModalities•Anatomy•FilmInterpretation2T
2、aylorLloyd,HMS3GillianLieberman,MDCase1•43yearoldfemalerestraineddriverinmotorvehiclecrashat40mph•Airbagdeployed•Feltimmediateneckpainwithoutradiation•Noweaknessofextremities,bowel,orbladderdysfunction•Alsoexperiencingsomehippain•Whatarethestructuresofconcern?•Whatistheroleofimaging?3TaylorLloyd,H
3、MS3GillianLieberman,MDMechanismsofSpinalInjuryEachtypeofforcetheoreticallyproducesacharacteristicinjuryRogersLFetal.“SkeletalTrauma.”InGrainger&Allison'sDiagnosticRadiology,5thed.,1016.Orlando:Churchill4Livingston,2008.TaylorLloyd,HMS3GillianLieberman,MDDifferentialDiagnosis(StructuresofConcern)•S
4、pinalcordinjury•Compression(hemorrhage,edema,spondylolethisis)•Transection•Vertebralfracture•Unstable•Stable•Ligamentousinjury•Unstable•Vascularinjuries•Vertebralarterialinjury:insomecaseseries,upto46%ofpatientswithMAJORbluntcervicaltrauma5TaylorLloyd,HMS3GillianLieberman,MDNEXUSguidelines:Toimage
5、ornottoimage..Basedonprospective,observationalstudy,n=34,069Highsensitivity,99.0%(95%CI98-99.6%)Lowspecificity,12.9%CervicalspineradiographyisindicatedunlessthepatientmeetsALL5criteria:✗–Noposteriormidlinecervicaltenderness✔–Noevidenceofintoxication✔–Normallevelofalertness✔–Nofocalneurologicdefici
6、t✗–NopainfuldistractinginjuryHoffmanJR.Validityofasetofclinicalcriteriatoruleoutinjurytothecervicalspineinpatientswithblunttrauma.National6EmergencyX‐RadiographyUtilizationStudyGroup.NEnglJMed.2000;343(2):94.TaylorLloyd,HMS3GillianLieberman,MDMenuofTests•PlainFilm–3views(lateral,odontoid,AP)•CT–Wi
7、thsagittalandcoronalreconstructions•MRI7TaylorLloyd,HMS3GillianLieberman,MDToCTornotCT..Basedonmeta-analysisof7randomizedcontroltrialsandcohortstudies,wherein3studiesn>1000Studyinclusioncriteria:CTandplainfilmsin
