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Evaluation of Occult Cervical Spine Fractures on Radiographs and CT 2003

Lin JT, Lee JL, Lee ST
University Hospital at Stony Brook
Stony Brook, NY

Purpose:
To evaluate occult cervical spine fractures on radiographs and CT.

Materials and Methods:
We reviewed radiographs of 68 patients with cervical spine fractures at a Level 1 trauma center.

Summary of Results:
26 cases showed occult fractures on initial radiographs. Of seven odontoid fractures, two were diagnosed only after thinner repeat CT reconstructions. Five facet fractures were best seen on CT reconstructions. Three occult Hangman fractures were seen by CT. A C1 fracture was diagnosed on CT only. Two fractures through the C2 body were seen only by CT. Eight fractures were obscured by patient ’s shoulders, including five Clay Shoveler’s fractures, a C6 facet fracture, a bilateral C6 pedicle fracture, and a C7/T1 fracture/dislocation.

Conclusion:
Odontoid, facet, and lower cervical spine fractures are most commonly occult on radiographs. CT, especially high-quality CT reconstructions for odontoid and facet fractures, can improve the diagnosis of cervical spine fracture.

Audiovisual requirement:
MS Powerpoint for Windows on CD
Presenting authors: Steven T. Lee, MD and Julie T. Lin, MD (non-ASSR members)
Previously presented at the 2000 Eastern Neuroradiological Society and 2000 American Society of Emergency Radiology Meeting.