Lateralized Odontoid in Plain Film Radiography: Sign of Fractures? A Comparison Study with MDCT

TY - JOUR

T1 - Lateralized Odontoid in Plain Film Radiography: Sign of Fractures? A Comparison Study with MDCT

AU - Keller, S

AU - Bieck, K

AU - Karul, M

AU - Schönnagel, B

AU - Adam, G

AU - Habermann, C

AU - Yamamura, J

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2015/9

Y1 - 2015/9

N2 - PURPOSE: To evaluate X-ray standards for the detection of odontoid fractures.SUMMARY OF BACKGROUND DATA: Cervical spine fractures are a common finding in emergency medicine, accounting for 1-3% of injuries. Involvement of the C1/C2 complex is found in 25% of cases, affecting the odontoid peg in 55-80%. Regarding the consequences of missed fractures, radiographic techniques built the groundwork for further treatment procedures. As standardized X-ray measurements have not been established, the incidence of unrecognized cervical spine fracture is expected to be up to 20%. The establishment of X-ray-based guidelines is also limited by the presumed low specificity and sensitivity of distance measurements caused by rotational distortion which leads to a rising popularity of CT.MATERIALS AND METHODS: 79 (age 60 ± 26 yrs) patients with lateralization of the odontoid process on conventional plain film radiography (anteroposterior, lateral, and open mouth odontoid process view projection) were examined. The distance between the odontoid process and lateral mass of C1, angles of vertical odontoid line and basis of C2 were measured in the ap view. In the lateral view, dorsal alignment and atlantodental distance were assessed. MDCT examinations were used as a reference. Discriminatory power test was applied to assess significance.RESULTS: 8/79 (10.1%) odontoid process fractures were found. Diagnosis was achieved on conventional radiographs in 6 patients. Neither distance and angle measurements between odontoid and C1 nor the dorsal alignment of the vertebral bodies differed significantly between healthy and affected patients.CONCLUSION: Decentralization of the odontoid process is not necessarily an indirect sign for its fracture. In patients with suspected injury of the odontoid process, an MDCT scan might be the method of choice to rule out a fracture.KEY POINTS: Due to the wide physiological variety of odontoid process position, even a detailed metric analysis of cervical alignment and odontoid process angulation in X-ray scans is not able to facilitate the diagnosis of odontoid process fractures. In the case of cervical spine trauma, which necessitate medical imaging, a primary MDCT scan should be the method of choice.

AB - PURPOSE: To evaluate X-ray standards for the detection of odontoid fractures.SUMMARY OF BACKGROUND DATA: Cervical spine fractures are a common finding in emergency medicine, accounting for 1-3% of injuries. Involvement of the C1/C2 complex is found in 25% of cases, affecting the odontoid peg in 55-80%. Regarding the consequences of missed fractures, radiographic techniques built the groundwork for further treatment procedures. As standardized X-ray measurements have not been established, the incidence of unrecognized cervical spine fracture is expected to be up to 20%. The establishment of X-ray-based guidelines is also limited by the presumed low specificity and sensitivity of distance measurements caused by rotational distortion which leads to a rising popularity of CT.MATERIALS AND METHODS: 79 (age 60 ± 26 yrs) patients with lateralization of the odontoid process on conventional plain film radiography (anteroposterior, lateral, and open mouth odontoid process view projection) were examined. The distance between the odontoid process and lateral mass of C1, angles of vertical odontoid line and basis of C2 were measured in the ap view. In the lateral view, dorsal alignment and atlantodental distance were assessed. MDCT examinations were used as a reference. Discriminatory power test was applied to assess significance.RESULTS: 8/79 (10.1%) odontoid process fractures were found. Diagnosis was achieved on conventional radiographs in 6 patients. Neither distance and angle measurements between odontoid and C1 nor the dorsal alignment of the vertebral bodies differed significantly between healthy and affected patients.CONCLUSION: Decentralization of the odontoid process is not necessarily an indirect sign for its fracture. In patients with suspected injury of the odontoid process, an MDCT scan might be the method of choice to rule out a fracture.KEY POINTS: Due to the wide physiological variety of odontoid process position, even a detailed metric analysis of cervical alignment and odontoid process angulation in X-ray scans is not able to facilitate the diagnosis of odontoid process fractures. In the case of cervical spine trauma, which necessitate medical imaging, a primary MDCT scan should be the method of choice.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Diagnosis, Differential

KW - False Negative Reactions

KW - Humans

KW - Middle Aged

KW - Multidetector Computed Tomography

KW - Odontoid Process

KW - Radiographic Image Interpretation, Computer-Assisted

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Spinal Fractures

KW - X-Ray Film

KW - Young Adult

U2 - 10.1055/s-0035-1553237

DO - 10.1055/s-0035-1553237

M3 - SCORING: Journal article

C2 - 26114250

VL - 187

SP - 801

EP - 807

JO - ROFO-FORTSCHR RONTG

JF - ROFO-FORTSCHR RONTG

SN - 1438-9029

IS - 9

ER -