The Journal of Bone and Joint Surgery (American). 2005;87:2388-2394.
doi:10.2106/JBJS.E.00208
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Helical Computed Tomography Alone Compared with Plain Radiographs with Adjunct Computed Tomography to Evaluate the Cervical Spine After High-Energy Trauma

Patrick T. McCulloch, MD1, John France, MD1, Dina L. Jones, PhD, PT1, William Krantz, MD2, Thuan-Phuong Nguyen, MD2, Craig Chambers, DO2, Joe Dorchak, MD2 and Peter Mucha, MD3

1 Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV 26506-9196. E-mail address for J. France: jfrance{at}hsc.wvu.edu
2 Department of Radiology, West Virginia University, P.O. Box 9235, Morgantown, WV 26506-9235
3 622 Headquarters Drive, Ottsville, PA 18942

Investigation performed at West Virginia University Hospitals, Morgantown, West Virginia

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Jon Michael Moore Trauma Center, West Virginia University. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or non-profit organization with which the authors are affiliated or associated.

Background: Current literature supports the use of the three-view plain-radiograph series supplemented, when necessary, with helical computed tomography to evaluate the cervical spine in patients who have sustained trauma injury. The purpose of this study was to determine if helical computed tomography alone can be used to evaluate the cervical spine for acute osseous injury following high-energy trauma, thus eliminating the need to make radiographs.

Methods: Patients were prospectively evaluated with helical computed tomography scanning of the cervical spine and standard three-view plain radiography. At a later date, the plain radiographs and computed tomography scans were independently reviewed by two radiologists who were blinded to both the initial interpretation and the interpretation of the corresponding study. The radiologists documented whether the plain radiographs were adequate and whether they showed an acute process. The findings in the study were compared with the initial findings and, when necessary, with the discharge summaries to determine if an injury had been identified. The accuracy of the plain radiographs, of the plain radiographs that had been deemed adequate, and of helical computed tomography used alone was ascertained.

Results: Plain radiographs and helical computed tomography scans were made for 407 patients, and traumatic injuries were identified in fifty-eight of them. Plain radiographs alone were adequate for 194 (48%) of the 407 patients. Plain radiographs had a sensitivity of 45%, a specificity of 97%, a positive predictive value of 74%, and a negative predictive value of 91%. Adequate plain radiographs had a sensitivity of 52%, a specificity of 98%, a positive predictive value of 81%, and a negative predictive value of 93%. Helical computed tomography had a sensitivity and specificity of 98%, a positive predictive value of 89%, and a negative predictive value of >99%. The sensitivity, positive predictive value, and negative predictive value of adequate plain radiographs differed significantly from those of helical computed tomography alone (p < 0.001). Twelve (48%) of twenty-five adequate plain radiographs of patients in whom an injury had been identified on computed tomography missed that injury. Helical computed tomography alone missed one (2%) of the fifty-eight injuries.

Conclusions: Although helical computed tomography has a limited ability to detect pure ligamentous injury, it can be safely used without plain radiographs to evaluate the cervical spine for osseous abnormalities such as fractures and dislocations after high-energy trauma.

Level of Evidence: Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.


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