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The diagnostic precision of computed tomography for traumatic cervical spine injury: An in vitro biomechanical investigation

  • Shun Yamamoto
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada

    Department of Orthopaedic Surgery, Jikei University Graduate School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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  • Tom Whyte
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
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  • Carolyn Van Toen
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
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  • Angela Melnyk
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
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  • Jason Shewchuk
    Affiliations
    Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W. 12th Ave., Vancouver, BC V5Z 1M9, Canada
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  • John Street
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
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  • Peter Cripton
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
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  • Thomas R. Oxland
    Correspondence
    Corresponding author at: Departments of Mechanical Engineering and Orthopaedics, University of British Columbia, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.
    Affiliations
    Orthopaedic and Injury Biomechanics Group, Departments of Mechanical Engineering and Orthopaedics and the School of Biomedical Engineering, University of British Columbia, Vancouver Campus, 2054-6250 Applied Science Lane, Vancouver, BC V6T 1Z4, Canada

    International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada
    Search for articles by this author

      Highlights

      • Anatomical dissection and computed tomography (CT) for in vitro fracture diagnosis.
      • Low sensitivity and precision of CT scanning for lateral mass and pedicle fractures.
      • Fractures relevant for clinical stability assessment may be missed with CT scan alone.

      Abstract

      Background

      CT is considered the best method for vertebral fracture detection clinically, but its efficacy in laboratory studies is unknown. Therefore, our objective was to determine the sensitivity, precision, and specificity of high-resolution CT imaging compared to detailed anatomic dissection in an axial compression and lateral bending cervical spine biomechanical injury model.

      Methods

      35 three-vertebra human cadaver cervical spine specimens were impacted in dynamic axial compression (0.5 m/s) at one of three lateral eccentricities (low 5% of the spine transverse diameter, middle 50%, high 150%) and two end conditions (19 constrained lateral translation and 16 unconstrained). All specimens were imaged using high resolution CT imaging (246 μm). Two clinicians (spine surgeon and neuroradiologist) diagnosed the vertebral fractures based on 34 discrete anatomical structures using both the CT images and anatomical dissection.

      Findings

      The sensitivity of CT was highest for fractures of the facet joint (59%) and vertebral endplate (57%), and was lowest for pedicle (13%) and lateral mass fractures (23%). The precision of CT was highest for spinous process fractures (83%) and lowest for pedicle (21%), uncinate process and lateral mass (both 23%) fractures. The specificity of CT exceeded 90% for all fractures. The Kappa value between the two reviewers was 0.52, indicating moderate agreement.

      Interpretation

      In this in vitro cervical spine injury model, high resolution CT scanning missed many fractures, notably those of the lateral mass and pedicle. This finding is potentially important clinically, as the integrity of these structures is important to clinical stability and surgical fixation planning.

      Keywords

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