Whole Spine CT Scan for the Detection of Acute Spinal Fractures in Diffuse Idiopathic Skeletal Hyperostosis Patients Who Sustained Low-energy Trauma.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Oct 2020
01 Oct 2020
Historique:
pubmed:
29
4
2020
medline:
17
12
2020
entrez:
29
4
2020
Statut:
ppublish
Résumé
Retrospective cohort study. The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma. Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure. One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated. Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures. WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort study.
OBJECTIVE
OBJECTIVE
The aim of this study was to evaluate the role and value of whole-spine computerized tomography (WSCT) versus radiographs and targeted CT to tender spinal regions in patients with diffuse idiopathic skeletal hyperostosis (DISH) after low-energy trauma.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Subjects with DISH are prone to spinal fractures even after low-impact trauma due to a rigid spinal structure.
METHODS
METHODS
One-hundred forty-seven subjects (average age: 83 years, M:F 64/83) with verified DISH (Resnick and Niwayama radiographic criteria) on WSCT who were admitted to the emergency room (ER) after low-energy trauma and for whom there were radiographs of at least the thoracic and lumbar spine were evaluated for the presence of acute spinal fractures on both radiographs and WSCT. Agreement between fracture location and spinal tenderness location (cervical, thoracic, or lumbar) as reported in the medical record was evaluated.
RESULTS
RESULTS
Significantly more acute fractures were detected on WSCT compared to radiographs (55 and 32, P < 0.00001, respectively). The site of tenderness was not indicative of the fractured spinal segment in 57% of all acute fractures (seven cervical, 15 thoracic, and 16 lumbar). No fracture was detected on WSCT in 10 subjects with an unspecified pain location. Multilevel distant fractures were detected in two patients with a specified pain location to only one of the fractures.
CONCLUSION
CONCLUSIONS
WSCT in DISH subjects after low-impact trauma is mandatory due to the high prevalence of acute fractures and the low specificity for fracture detection on radiographs. A targeted CT approach to the tender spinal segment proved to be inadequate and would have missed 57% of the acute single fractures with incompatible spinal tenderness location. These results support the significant role of WSCT in the ER setting for detecting and pinpointing the spinal fracture site of DISH subjects who present with low-impact trauma.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 32341308
doi: 10.1097/BRS.0000000000003536
pii: 00007632-202010010-00015
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1348-1353Références
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