Skip to main content
SpringerLink
Log in

Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Although many reports advocate computed tomography (CT) as the initial surveillance tool for occult cervical spine injury (CSI) at the emergency department (ED), the role of a lateral cervical spine radiograph (LCSX) has still not been replaced. We hypothesized that the increased width of the prevertebral soft tissue on an LCSX provides helpful information for selecting the high-risk patients who need to be evaluated with more accurate diagnostic tools.

Methods

This was a retrospective and consecutive series of injured patients requiring cervical spine evaluation who were first imaged with three-view plain films at the ED. The prevertebral soft tissue thickness (PVST) and ratio of prevertebral soft tissue thickness to the cervical vertebrae diameter (PVST ratio) were calculated on the LCSX. Suspicion of CSI was confirmed by either CT or magnetic resonance imaging (MRI) scans.

Results

A total of 826 adult trauma patients requiring cervical spine evaluation were enrolled. The C3 PVST and PVST ratio were significantly different between patients with or without upper cervical area injury (UCAI, 8.64 vs. 5.49 mm, and 0.394 vs. 0.276, respectively), and, likewise, the C6 PVST and PVST ratio for patients with or without lower cervical area injury (LCAI, 16.89 vs. 14.66 mm, and 0.784 vs. 0.749, respectively). The specificity was greater than 90 % in predicting UCAI and LCAI when combining these two parameters.

Conclusions

This method maximizes the usefulness of LCSX during the initial assessment of a conscious patient with blunt head and neck injury, especially for the identification of high-risk patients requiring prompt CT or MRI; on the other hand, it prevents the overuse of these high-cost imaging studies as initial diagnostic tools.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Davis JW, Phreaner DL, Hoyt DB, Mackersie RC. The etiology of missed cervical spine injuries. J Trauma. 1993;34:342–6.

    Article  PubMed  CAS  Google Scholar 

  2. Grossman MD, Reilly PM, Gillett T, Gillett D. National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers. J Trauma. 1999;47:684–90.

    Article  PubMed  CAS  Google Scholar 

  3. Platzer P, Hauswirth N, Jaindl M, Chatwani S, Vecsei V, Gaebler C. Delayed or missed diagnosis of cervical spine injuries. J Trauma. 2006;61:150–5.

    Article  PubMed  Google Scholar 

  4. Fisher A, Young WF. Is the lateral cervical spine x-ray obsolete during the initial evaluation of patients with acute trauma? Surg Neurol. 2008;70:53–7.

    Article  PubMed  Google Scholar 

  5. Mathen R, Inaba K, Munera F, Teixeira PG, Rivas L, McKenney M, Lopez P, Ledezma CJ. Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. J Trauma. 2007;62:1427–31.

    Article  PubMed  Google Scholar 

  6. Steigelman M, Lopez P, Dent D, Myers J, Corneille M, Stewart R, Cohn S. Screening cervical spine MRI after normal cervical spine CT scans in patients in whom cervical spine injury cannot be excluded by physical examination. Am J Surg. 2008;196:857–63.

    Article  PubMed  Google Scholar 

  7. Diaz JJ Jr, Aulino JM, Collier B, Roman C, May AK, Miller RS, Guillamondegui O, Morris JA Jr. The early work-up for isolated ligamentous injury of the cervical spine: does computed tomography scan have a role? J Trauma. 2005;59:897–904.

    Article  PubMed  Google Scholar 

  8. American College of Surgeons Committee on Trauma. Advanced trauma life support manual. 8th ed. Chicago: American College of Surgeons; 2008. p. 166–8.

    Google Scholar 

  9. British Trauma Society. Guidelines for the initial management and assessment of spinal injury. British Trauma Society, 2002. Injury. 2003;34:405–25.

    Article  Google Scholar 

  10. Pasquale M, Fabian TC. Practice management guidelines for trauma from the Eastern Association for the Surgery of Trauma. J Trauma. 1998;44:941–56.

    Article  PubMed  CAS  Google Scholar 

  11. Griffen MM, Frykberg ER, Kerwin AJ, Schinco MA, Tepas JJ, Rowe K, Abboud J. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan? J Trauma. 2003;55:222–6.

    Article  PubMed  Google Scholar 

  12. Muchow RD, Resnick DK, Abdel MP, Munoz A, Anderson PA. Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis. J Trauma. 2008;64:179–89.

    Article  PubMed  Google Scholar 

  13. DeBehnke DJ, Havel CJ. Utility of prevertebral soft tissue measurements in identifying patients with cervical spine fractures. Ann Emerg Med. 1994;24:1119–24.

    Article  PubMed  CAS  Google Scholar 

  14. Keats TE, Sistrom C. Atlas of radiologic measurement. St. Louis: Mosby; 2001. p. 87–8.

    Google Scholar 

  15. Nuñez DB Jr, Quencer RM. The role of helical CT in the assessment of cervical spine injuries. AJR Am J Roentgenol. 1998;171:951–7.

    Article  PubMed  Google Scholar 

  16. Lufkin RB, Borges A, Villablanca P. Teaching atlas of head and neck imaging. New York: Thieme; 2000. p. 174–6.

    Google Scholar 

  17. Herr CH, Ball PA, Sargent SK, Quinton HB. Sensitivity of prevertebral soft tissue measurement of C3 for detection of cervical spine fractures and dislocations. Am J Emerg Med. 1998;16:346–69.

    Article  PubMed  CAS  Google Scholar 

  18. Templeton PA, Young JW, Mirvis SE, Buddemeyer EU. The value of retropharyngeal soft tissue measurements in trauma of the adult cervical spine. Cervical spine soft tissue measurements. Skeletal Radiol. 1987;16:98–104.

    Article  PubMed  CAS  Google Scholar 

  19. Dai LY. Significance of prevertebral soft tissue measurement in cervical spine injuries. Eur J Radiol. 2004;51:73–6.

    Article  PubMed  Google Scholar 

  20. Penning L. Prevertebral hematoma in cervical spine injury: incidence and etiologic significance. AJR Am J Roentgenol. 1981;136:553–61.

    Article  PubMed  CAS  Google Scholar 

  21. Daffner RH, Sciulli RL, Rodriguez A, Protetch J. Imaging for evaluation of suspected cervical spine trauma: a 2-year analysis. Injury. 2006;37:652–8.

    Article  PubMed  CAS  Google Scholar 

  22. Sistrom CL, Southall EP, Peddada SD, Shaffer HA Jr. Factors affecting the thickness of the cervical prevertebral soft tissues. Skeletal Radiol. 1993;22:167–71.

    Article  PubMed  CAS  Google Scholar 

  23. Rojas CA, Vermess D, Bertozzi JC, Whitlow J, Guidi C, Martinez CR. Normal thickness and appearance of the prevertebral soft tissues on multidetector CT. AJNR Am J Neuroradiol. 2009;30:136–41.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

Jiun-Pyng Shiau, Cheng-Chih Liao, and the other co-authors did not receive any funding for this work and declare no conflicts of interest with respect to the present work.

Author information

Authors and Affiliations

  1. Department of General Surgery, Tzu-Chi General Hospital and Tzu-Chi University, No.289, Jianguo Rd., Xindian Dist, New Taipei City , 23142, Taiwan, ROC

    J.-P. Shiau

  2. Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC

    J.-P. Shiau, C.-N. Yeh & C.-C. Liao

  3. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC

    C.-C. Chin

  4. Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC

    J.-F. Chen, S.-T. Lee & C.-C. Liao

  5. Division of Trauma, Department of General Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing St., Guishan Township, Taoyuan County, 333, Taiwan, ROC

    J.-F. Fang

Authors
  1. J.-P. Shiau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C.-C. Chin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C.-N. Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J.-F. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S.-T. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J.-F. Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C.-C. Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.-C. Liao.

Additional information

This manuscript has not been published nor is under consideration by another journal. This study has been approved by the Institutional Review Board (IRB) committee of Chang Gung Memorial Hospital.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shiau, JP., Chin, CC., Yeh, CN. et al. Does the ratio and thickness of prevertebral soft tissue provide benefit in blunt cervical spine injury?. Eur J Trauma Emerg Surg 39, 297–303 (2013). https://doi.org/10.1007/s00068-013-0270-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-013-0270-x

Keywords

Search

Navigation