ARAs C2–7 were obtained, and maximum and minimum values were calculated for all groups. MRI of cervical spine revealed altered signal intensity of C5 vertebral body in the form of T2/STIR hyperintensity and T1 hypointensity suggestive of marrow oedema [Fig. Straightening of the cervical spine in the acute setting may be secondary to muscular trauma, and a focal kyphosis may ensue at a later time. This supports an earlier stated hypothesis of the stabilizing and therefore straightening effect of CCI on the C-spine. Table 1. The understanding of what treatment may help them the best and the controversies and confusion that surround these treatments. However, when there is … The purpose of this study was:to evaluate whether statistically significant differences in the cervical alignment, lordosis, kyphosis or straightening can be observed in adult patients undergoing MDCT after single trauma exposureto evaluate whether loss of lordosis or straightening of the C-spine in the supine position alone can be considered a significant MDCT finding when screening for C-spine injuries andto evaluate the influence of CCI on the cervical alignment in patients undergoing MDCT after head/neck trauma. Straightening of the cervical lordosis, then, means straightening of the normal neck curve. The control group revealed no significant differences. 32 years experience Diagnostic Radiology Loss: of cervical lordosis means straightening of the normal curve of the cervical spine. This could also increase the number of “straight” C-spine cases among patients with CCI and the difference in C-spine alignment distribution between both trauma patient groups. Statistically, however, the differences were of no significance. The taper ratio of the spinal canal was calculated with the regression line. The study group was divided into two subgroups: (1) with CCI (n = 80) and (2) without CCI (n = 80); for more details, see Table 1. A p-value ≤ 0.05 was considered to be statistically significant. A thorough survey of the literature on this topic revealed controversial opinions on the significance of a “normal” cervical curve in lateral CR radiographs.7,17–21. MDCT is becoming increasingly important for C-spine trauma imaging for adults. Therefore “straightening” of the C-spine alone should not be considered a reliable pathological imaging sign in screening trauma patients undergoing MDCT. Other authors, such as Grob et al,19 also could not demonstrate a correlation between cervical alignment changes, straightening or kyphosis and neck pain and muscle spasm. To evaluate whether straightening of the cervical spine (C-spine) alignment after trauma can be considered a significant multidetector CT (MDCT) finding. More than 85 percent of people older than age 60 are affected by cervical spondylosis.Most people experience no symptoms from these problems. Cervical Spine Trauma: Pearls and Pitfalls Accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervi-cal spine CT, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings. car accident) may be a direct cause of straightening of the neck curve, there are other issues that may straighten our cervical spine … © 2016 The Authors. The detailed results for the control group are shown in Table 2 and Figure 2. As no definite C-spine curve angles and cut-off values have been reported in literature so far for patients in the supine position undergoing MDCT with or without CCI, values for ARA C2–7 were adapted from literature data for patients undergoing upright CR imaging. Roentgenographic variations in the normal cervical spine, Sagittal alignment of the cervical spine after neck injury, Roentgenographic signs of cervical injury, Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis, Relationship between alignment of upper and lower cervical spine in asymptomatic individuals, Correlation of cervical lordosis measurement with incidence of motor vehicle accidents. For the purpose of these studies, however, imaging was performed in the upright position and mostly without CCI.18,22,23, The emerging role of MDCT in C-spine evaluation raised the question as to what extent changes in C-spine alignment may be considered normal for immobilized and non-immobilized patients after trauma. It was also observed that in both trauma patient groups, straight alignment and segmental kyphosis appeared in 19–21% of the cases, and it was more common at the C5/6 segment. The resulting average ARA C2–7 values for both patient groups are represented in Table 3. Another group, Beltsios et al,22 recently studied the incidence of normal cervical lordosis among 60 and 100 healthy patients using MDCT and compared their results with the changes in patients with a neck injury, applying CR and MDCT. patients without history of trauma who underwent oncologic imaging studies, had a mean age of 33 years (SD ± 6.53) and was analysed in accordance with the criteria for the study group and evaluated against normal values known from upright CR imaging (normal upright-CR ARA C2–7) which had been obtained from literature data. Today, it is a clinically well-evaluated and evidence-based fact that MDCT is superior to CR regarding detection of C-spine injuries. They observed no significant differences between the trauma and non-trauma groups, and they concluded that the coincidental alterations in normal cervical lordosis may not necessarily be related to the trauma itself. All measurements were performed on standard picture archiving and communication system workstations (AGFA Impax™; Agfa Healthcare, Köln, Germany) using the manufacturer's software for angle measurements. Study group: absolute rotational angle (ARA) C2–7 values (°), split into cervical spine alignment groups (lordosis, kyphosis and straight) according to defined angle values. Following today's established clinical indication guidelines such as the National Emergency X-Radiography Utilization Study (NEXUS) and Canadian Cervical Spine Rule (CCR), which are based on comprehensive prospective multicentre studies; CR imaging can be used instead of CT only for neurologically intact and alert patients, who are considered low risk. Based on prior published data, the following cut-off angle/alignment values were defined to group the patients as follows: lordosis <−13°; straight −13° to +6°; kyphosis >+6°. all humans are born with a straight or reversed cervical curve from being in the “fetal” position while in the womb. Cervical lordosis is a curvature of the cervical spine or the vertebrae in the neck region. Most studies addressing this issue have focused on lordosis measurements using CR imaging for patients without a history of head/neck trauma. Reassessment of the craniocervical junction: normal values on CT, Sagittal plane segmental motion of the cervical spine. to evaluate whether statistically significant differences in the cervical alignment, lordosis, kyphosis or straightening can be observed in adult patients undergoing MDCT after single trauma exposure, to evaluate whether loss of lordosis or straightening of the C-spine in the supine position alone can be considered a significant MDCT finding when screening for C-spine injuries and. Study group, patient demographics: age, gender and incidence of degenerative spine disease. The emerging role of MDCT in C-spine evaluation raised the question as to what extent changes in C-spine alignment may be considered normal for immobilized and non-immobilized patients after trauma. All humans acquire a cervical curve or “lordodic curve” when they begin to crawl and raise their heads in that crawling position. A cut-off age of 50 years was imposed to exclude age-dependent degenerative changes of the C-spine, which can impair the normal alignment before traumano obvious signs of injury to the head, neck and spine; exclusion of skull and vertebral fractures as well as intra- and extra-axial haematoma and ligamentous injuries, which can alter the alignment by itself. However, in both groups, male patients (61% and 71%) tended to be more involved in traumatic accidents (Table 1). Fluid-sensitive sequences on MRI may show high signal in the posterior soft tissues, corresponding to … In this group, 35% (n = 6) of the patients revealed a lordotic alignment (mean 22.00; SD 6.39°), 60% of the patients (n = 12) revealed a straight C-spine alignment (mean 5.75; SD 5.01°), and one patient (5%) had a kyphotic alignment (+14°). Three patients from the control group underwent MDCT of the C-spine repeatedly (in 2- to 3-month intervals), and there were obvious deviations in the C-spine alignment between individual examinations. A new precision measurement protocol and normal motion data of healthy adults, Mean age (years) irrespective of gender (SD), Signs of initial degenerative spine disease (%), Mean age (years) for patients with initial degenerative spine disease (SD). Straightening of the C-spine alone is not a definitive sign of injury but is a biomechanical variation due to CCI and neck positioning during MDCT or active patient control. From this pool, 160 continuous MDCT examinations (study group) that met the following criteria were considered for the study: The study group was divided into two subgroups: (1) with CCI (, MDCT was performed on two 64-row scanners (VCT64 and HD750; GE, Milwaukee, WI) using a standard scanning protocol for patients with a suspected C-spine trauma: 120 kV, native helical scan with. Hover on/off image to show/hide findings. Straightening of the C-spine alignment in MDCT alone is not a definitive sign of injury. The straight cervical spine: does it indicate muscle spasm? The RRA measurements for the patient groups with CCI (CCI+) showed segmental kyphosis in 17 (21%) individuals: 58% (n = 10) of them at the C5/6 level (mean +8.81, SD 3.22°), 29% (n = 5) of them at the C4/5 level (mean +7.83, SD 2.93°) and 12% (n = 2) of them at the C2–C4 level (mean +6.00, SD 2.00°) (Figure 4). Student's t-test was used to determine the statistical significance of angle values between the two groups and for each subtype of cervical alignment (IBM Corp., New York, NY; formerly SPSS® Inc., Chicago, IL). For the purpose of these studies, however, imaging was performed in the upright position and mostly without CCI.18,22,23, The emerging role of MDCT in C-spine evaluation raised the question as to what extent changes in C-spine alignment may be considered normal for immobilized and non-immobilized patients after trauma. The condition describes a spinal state in which the normal lumbar or cervical region is reduced in its degree of front to back curvature, also medically known as hypolordosis. It was also observed that in both trauma patient groups, straight alignment and segmental kyphosis appeared in 19–21% of the cases, and it was more common at the C5/6 segment. The “C” shape points towards the back region of the neck. The RRA measurements for the patient groups with CCI (CCI+) showed segmental kyphosis in 17 (21%) individuals: 58% (n = 10) of them at the C5/6 level (mean +8.81, SD 3.22°), 29% (n = 5) of them at the C4/5 level (mean +7.83, SD 2.93°) and 12% (n = 2) of them at the C2–C4 level (mean +6.00, SD 2.00°) (Figure 4). Plain radiograph of cervical spine lateral view showed straightening of cervical spine [Fig. Therefore no consensus decisions were necessary. Spinal fusion is needed more often when stenosis surgery is performed in the cervical spine because that area tends to become unstable as a result of spinal decompression. Following the analysis of our non-traumatized control group, we found that even in this group “straight” alignment in supine patients is statistically significantly predominant over lordotic alignment (60% vs 35%, respectively), and even if straight and kyphotic alignments were pooled, there were no statistical differences (control group 65% vs CCI− 67%) to the study group without CCI. Follow these hacks each day to improve, protect, and straighten your spine. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).Cervical spondylosis is very common and worsens with age. In 1975, Weir reviewed 360 asymptomatic patients and found 20 percent to have either straight or reversed cervical curves in … At C2-C3 and C3-C4 subtle anterolisthesis. Other patients, even single-trauma cases among adults, should be treated as high-risk patients and regularly undergo MDCT.5,15,16, Recently, low-dose MDCT protocols were developed and promoted for the use in C-spine imaging, leading to a rapid decrease of the use of CR for C-spine trauma patients in many emergency departments.6, Loss of lordosis and straightening are often considered to be signs of muscular strain of the C-spine and have served as an indirect sign of cervical trauma or distortion in CR imaging for a long time.7,17 However, it remains unclear whether or to what extent C-spine straightening can be observed in MDCT, and what impact cervical collar immobilization (CCI) can have on the straightening, which is obligatory for patients with assumed C-spine trauma.7,18–21, Most studies addressing this issue have focused on lordosis measurements using CR imaging for patients without a history of head/neck trauma. 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