The Secondary Contiguous or Non-contiguous Subchondral Bone Impactions in Subaxial Cervical Spinal Injury: Incidence and Associated Primary Injury Patterns
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Purpose : To evaluate the incidence of secondary contiguous or non-contiguous subchondral bone impactions (SBI) insubaxial cervical spinal injury and associated primary injury patterns. Materials and Methods: A retrospective review of computed tomography, magnetic resonance imaging, and medicalrecords was carried out for 47 patients who had sustained a subaxial cervical spinal injury. Presence, number, level, andsites of secondary contiguous or non-contiguous SBI were recorded. To evaluate primary injury patterns, the level andnumber of primary injury sites of subaxial cervical spine injury, injury morphology, anterior/posterior discoligamentouscomplex (ADC/PDC) injury, posterior ligamentous complex (PLC) injury, spinal cord injury, and mechanism of injury (MOI)were analyzed. Differences in primary injury pattern of subaxial cervical spine injury and MOI between patients with andwithout SBI, and between contiguous or non-contiguous SBI were analyzed using the Mann-Whitney U test, Pearson’s chisquare test and Fisher’s exact test. Results: Eighteen patients (18/47, 38.29%) had developed contiguous (n=9) or non-contiguous (n=9) SBI, most commonlyinvolving T3 (15/47, 31.91%) and 3 levels (6/18, 33.33%). All SBIs had developed near the anterosuperior regionof the body and the superior endplate and were the result of a high-impact MOI. SBIs were statistically significant in associationwith injury morphology and PLC injury (P=0.001, P=0.009, respectively) at the primary injury site. Non-contiguousSBI was more frequently accompanied by upper cervical spinal injuries in association with PDC injuries, as opposed to contiguousSBI, with statistical significance (P=0.009), while no other statistically significant differences were found. Conclusion: Secondary SBIs are common and probably associated with subaxial cervical spinal injuries with high energycompressive flexion forces.
Abstract
Purpose : To evaluate the incidence of secondary contiguous or non-contiguous subchondral bone impactions (SBI) insubaxial cervical spinal injury and associated primary injury patterns. Materials and Methods: A retrospective review of computed tomography, magnetic resonance imaging, and medicalrecords was carried out for 47 patients who had sustained a subaxial cervical spinal injury. Presence, number, level, andsites of secondary contiguous or non-contiguous SBI were recorded. To evaluate primary injury patterns, the level andnumber of primary injury sites of subaxial cervical spine injury, injury morphology, anterior/posterior discoligamentouscomplex (ADC/PDC) injury, posterior ligamentous complex (PLC) injury, spinal cord injury, and mechanism of injury (MOI)were analyzed. Differences in primary injury pattern of subaxial cervical spine injury and MOI between patients with andwithout SBI, and between contiguous or non-contiguous SBI were analyzed using the Mann-Whitney U test, Pearson’s chisquare test and Fisher’s exact test. Results: Eighteen patients (18/47, 38.29%) had developed contiguous (n=9) or non-contiguous (n=9) SBI, most commonlyinvolving T3 (15/47, 31.91%) and 3 levels (6/18, 33.33%). All SBIs had developed near the anterosuperior regionof the body and the superior endplate and were the result of a high-impact MOI. SBIs were statistically significant in associationwith injury morphology and PLC injury (P=0.001, P=0.009, respectively) at the primary injury site. Non-contiguousSBI was more frequently accompanied by upper cervical spinal injuries in association with PDC injuries, as opposed to contiguousSBI, with statistical significance (P=0.009), while no other statistically significant differences were found. Conclusion: Secondary SBIs are common and probably associated with subaxial cervical spinal injuries with high energycompressive flexion forces.
참고문헌 (26)
- Griffith HB, "Changing patterns of fracture in the dorsal and lumbar spine", Br Med J, 1, pp.891~894 (1966)
- Bentley G, "Multiple spinal injuries", Br J Surg, 55, pp.565~570 (1968)
- Kewalramani LS, "Multiple non-contiguous injuries to the spine", Acta Orthop Scand, 47, pp.52~58 (1976)
- Calenoff L, "Multiple level spinal injuries: importance of early recognition", AJR Am J Roentgenol, 130, pp.665~669 (1978)
- Korres DS, "Double or multiple level fractures of the spine", Injury, 13, pp.147~152 (1981)
- Tearse DS, "Management of noncontiguous vertebral fractures", Paraplegia, 25, pp.100~105 (1987)
- Gupta A, "Multilevel spinal injuries. Incidence, distribution and neurological patterns", J Bone Joint Surg Br, 71, pp.692~695 (1989)
- Keenen TL, "Non-contiguous spinal fractures", J Trauma, 30(4), pp.489~491 (1990)
- Henderson RL, "Multiple noncontiguous spine fractures", Spine (Phila Pa 1976), 16, pp.128~131 (1991)
- Vaccaro AR, "Noncontiguous injuries of the spine", J Spinal Disord, 5, pp.320~329 (1992)
- Green RA, "Whole spine MRI in the assessment of acute vertebral body trauma", Skeletal Radiol, 33, pp.129~135 (2004)
- Qaiyum M, "MRI detection of unsuspected vertebral injury in acute spinal trauma:incidence and significance", Skeletal Radiol, 30, pp.299~304 (2001)
- Eustace S, "MR imaging of bone oedema: mechanisms and interpretation", Clinical Radiology, 56, pp.4~12 (2001)
- Teli M, "Radiographic outcome of vertebral bone bruise associated with fracture of the thoracic and lumbar spine in adults", Eur Spine J, 14, pp.541~545 (2005)
- Sanders TG, "Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury", Radiographics, 20, pp.S135~S151 (2000)
- Sijbrandij ES, "Posttraumatic subchondral bone contusions and fractures of the talotibial joint: occurrence of “kissing” lesions", AJR Am J Roentgenol, 175, pp.1707~1710 (2000)
- Vaccaro AR, "The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex", Spine (Phila Pa 1976), 32, pp.2365~2374 (2007)
- Aarabi B, "Subaxial cervical spine injury classification systems", Neurosurgery, 72, pp.170~186 (2013)
- Goradia D, "Correlation of MR imaging findings with intraoperative findings after cervical spine trauma", AJNR Am J Neuroradiol, 28, pp.209~215 (2007)
- Demaerel P, "Magnetic resonance imaging of spinal cord trauma:a pictorial essay", Neuroradiology, 48, pp.223~232 (2006)
- Bohndorf K, "Imaging of acute injuries of the articular surfaces (chondral, osteochondral and subchondral fractures)", Skeletal Radiol, 28, pp.545~560 (1999)
- Delgado Almandoz JE, "Multidetector CT angiography in the evaluation of acute blunt head and neck trauma: a proposed acute craniocervical trauma scoring system", Radiology, 254, pp.236~244 (2010)
- Soo-Jung Choi, "Non-Contiguous Spinal Injury in Cervical Spinal Trauma: Evaluation with Cervical Spine MRI", Korean Journal of Radiology, 5(4), pp.219~224 (2004), 대한영상의학회
- Panjabi MM, "Basic biomechanics of the spine", Neurosurgery, 7, pp.76~93 (1980)
- Allen BL Jr., "A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine", Spine (Phila Pa 1976), 7, pp.1~27 (1982)
- Rihn JA, "Assessment of the posterior ligamentous complex following acute cervical spine trauma", J Bone Joint Surg Am, 92, pp.583~589 (2010)