Articles: spinal-injuries-diagnostic-imaging.
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Review Comparative Study
Computed tomography diagnosis of facet dislocations: the "hamburger bun" and "reverse hamburger bun" signs.
Unilateral or bilateral facet dislocations are difficult to diagnose. Computed tomography (CT) is being used more extensively to screen patients with suspected cervical vertebral injury. ⋯ Normal facet joints are oriented on a CT examination so that they resemble the sides of a hamburger bun. Facet dislocations upset this relationship and reverse the orientation of the "bun" halves to each other.
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Arch Orthop Trauma Surg · Jul 2001
Comparative StudyRadiographic evaluation of cervical spine trauma. Plain radiography and conventional tomography versus computed tomography.
Different imaging modalities are available for the diagnosis of cervical spine injuries. There is a controversial discussion about whether plain radiography (PR), conventional tomography (CTO) or computed tomography (CT) should primarily be used. PR and CTO are more often available and less costly than CT. ⋯ For PR and CTO the detection rates were lower for fractures of the dens than for the rest of the cervical spine. We conclude that the combination of PR and CTO accurately detects fractures of the cervical spine compared with CT. If a fracture of the dens is suspected, the patients should be referred to CT due to its superior accuracy in this region.
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The vertebral arteries appear to be particularly susceptible to injury in trauma of the cervical spine because of their close anatomical relationship to the spine; however, traumatic subintimal dissection of the vertebral artery is rare judging from the paucity of cases reported in the literature. The case of a patient who developed a visual field defect secondary to a fracture-subluxation of the cervical spine is reported. Angiography demonstrated an intimal dissection of the vertebral artery at the site of the fracture-subluxation resulting in thrombus formation and subsequently in emboli occluding the posterior temporal branch of the posterior cerebral artery. Early angiography is recommended if extracranial injury of the vertebral artery is suspected, and the institution of heparin therapy is necessary if a subintimal dissection is demonstrated.
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In a retrospective study of 65 patients with spinal trauma, computed tomography was found to add to plain radiography clinically relevant information in 47 patients. It was most helpful in identifying unsuspected neural arch fractures and in assessing spinal canal narrowing. Computed tomography is of great value in pretreatment evaluation and in follow-up of the patient with significant spinal trauma.