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Utility of helical computed tomography in differentiating unilateral and bilateral facet dislocations.

Publication ,  Journal Article
Dailey, AT; Shaffrey, CI; Rampersaud, R; Lee, J; Brodke, DS; Arnold, P; Nassr, A; Harrop, JS; Grauer, J; Bono, CM; Dvorak, M; Vaccaro, A
Published in: J Spinal Cord Med
2009

OBJECTIVE: Diagnosis of cervical facet dislocation is difficult when relying on plain radiographs alone. This study evaluates the interobserver reliability of helical computed tomography (CT) in the assessment of cervical translational injuries, correlates the radiographic diagnosis with intraoperative observation, and examines the role of neurologic injury in the evaluation and diagnosis of these injuries. METHODS: Clinical histories and radiographic studies of 10 patients with cervical facet dislocations were presented to 25 surgeons. Participants classified cases as unilateral or bilateral facet dislocations after reviewing selected axial CT slices and sagittal reconstructions. Surgeons' interpretations were compared with intraoperative diagnosis. Participants interpreted the same radiographic studies with 3 different clinical scenarios: neurologically intact, incomplete, and complete spinal cord injury. Vertebral body translation from midsagittal CT was evaluated to confirm whether all unilateral facet dislocations had <25% translation. RESULTS: Interrater kappa coefficient showed moderate agreement between observers in classifying injuries as unilateral or bilateral (kappa: 0.54-0.58), regardless of neurologic status. Percent agreement among observers varied from 50% to 100% for each individual case. Agreement was statistically higher for bilateral facet dislocation (85%) than for unilateral dislocations (78%), with 1 unilateral fracture showing nearly 50% translation on a midsagittal image. CONCLUSIONS: The addition of helical CT to reconstruction enables spine surgeons to more reliably distinguish bilateral from unilateral cervical facet dislocations. Despite frequent occurrence of these injuries and presumed agreement on injury description, agreement may be improved by a more precise definition of facet dislocations and subluxations and thorough review of all imaging studies.

Duke Scholars

Published In

J Spinal Cord Med

DOI

ISSN

1079-0268

Publication Date

2009

Volume

32

Issue

1

Start / End Page

43 / 48

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Rehabilitation
  • Joint Dislocations
  • Humans
  • Functional Laterality
  • Cervical Vertebrae
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences
  • 1106 Human Movement and Sports Sciences
  • 1103 Clinical Sciences
 

Citation

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Dailey, A. T., Shaffrey, C. I., Rampersaud, R., Lee, J., Brodke, D. S., Arnold, P., … Vaccaro, A. (2009). Utility of helical computed tomography in differentiating unilateral and bilateral facet dislocations. J Spinal Cord Med, 32(1), 43–48. https://doi.org/10.1080/10790268.2009.11760751
Dailey, Andrew T., Christopher I. Shaffrey, Raja Rampersaud, Joonyung Lee, Darrel S. Brodke, Paul Arnold, Ahmad Nassr, et al. “Utility of helical computed tomography in differentiating unilateral and bilateral facet dislocations.J Spinal Cord Med 32, no. 1 (2009): 43–48. https://doi.org/10.1080/10790268.2009.11760751.
Dailey AT, Shaffrey CI, Rampersaud R, Lee J, Brodke DS, Arnold P, et al. Utility of helical computed tomography in differentiating unilateral and bilateral facet dislocations. J Spinal Cord Med. 2009;32(1):43–8.
Dailey, Andrew T., et al. “Utility of helical computed tomography in differentiating unilateral and bilateral facet dislocations.J Spinal Cord Med, vol. 32, no. 1, 2009, pp. 43–48. Pubmed, doi:10.1080/10790268.2009.11760751.
Dailey AT, Shaffrey CI, Rampersaud R, Lee J, Brodke DS, Arnold P, Nassr A, Harrop JS, Grauer J, Bono CM, Dvorak M, Vaccaro A. Utility of helical computed tomography in differentiating unilateral and bilateral facet dislocations. J Spinal Cord Med. 2009;32(1):43–48.
Journal cover image

Published In

J Spinal Cord Med

DOI

ISSN

1079-0268

Publication Date

2009

Volume

32

Issue

1

Start / End Page

43 / 48

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Rehabilitation
  • Joint Dislocations
  • Humans
  • Functional Laterality
  • Cervical Vertebrae
  • 4201 Allied health and rehabilitation science
  • 3202 Clinical sciences
  • 1106 Human Movement and Sports Sciences
  • 1103 Clinical Sciences