Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?
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ORIGINAL ARTICLE
Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury? J.-P. Shiau • C.-C. Chin • C.-N. Yeh • J.-F. Chen • S.-T. Lee • J.-F. Fang • C.-C. Liao
Received: 28 June 2012 / Accepted: 10 February 2013 / Published online: 13 March 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools. Methods This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who This manuscript has not been published nor is under consideration byanother journal. This study has been approved by the Institutional Review Board (IRB) committee of Chang Gung Memorial Hospital. J.-P. Shiau Department of General Surgery, Tzu-Chi General Hospital and Tzu-Chi University, No.289, Jianguo Rd., Xindian Dist, New Taipei City 23142, Taiwan, ROC e-mail: [email protected] J.-P. Shiau C.-N. Yeh C.-C. Liao Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan, ROC e-mail: [email protected]
were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans. Results A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters. J.-F. Chen e-mail: [email protected] S.-T. Lee e-mail: [email protected] J.-F. Fang Division of Trauma, Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan, ROC e-mail: [email protected]
C.-C. Chin Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan, ROC e-mail: [email protected] J.-F. Chen S.-T. Lee C.-C. Liao (&) Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan, ROC e
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