Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

Joost Johannes van Middendorp; Ian Cheung; Kristian Dalzell; Hamish Deverall; Brian J C Freeman; Stephen A C Morris; Simon J I Sandler; Richard Williams; Y H Yau; Ben Goss

doi:10.4184/asj.2015.9.3.327

Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients

Asian Spine J. 2015 Jun;9(3):327-37. doi: 10.4184/asj.2015.9.3.327. Epub 2015 Jun 8.

Authors

Affiliations

¹ Stoke Mandeville Spinal Foundation, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. ; Harris Manchester College, University of Oxford, Oxford, UK.
² Logan Hospital, Logan City, QLD, Australia.
³ Department of Orthopaedics, Christchurch Hospital, Christchurch, New Zealand.
⁴ Department of Orthopaedics, Waikato Hospital, Hamilton, New Zealand.
⁵ The Spinal Unit, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia. ; The University of Adelaide, Adelaide, SA, Australia.
⁶ Department of Orthopaedics Great Ormond Street Hospital, London, UK.
⁷ The Spinal Unit, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
⁸ Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia. ; Trauma Service, Princess Alexandra Hospital, Brisbane, QLD, Australia.
⁹ AOSpine Reference Centre, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.

Abstract

Study design: Radiologic imaging measurement study.

Purpose: To assess the accuracy of detecting lateral mass and facet joint injuries of the subaxial cervical spine on plain radiographs using computed tomography (CT) scan images as a reference standard; and the integrity of morphological landmarks of the lateral mass and facet joints of the subaxial cervical spine.

Overview of literature: Injuries of lateral mass and facet joints potentially lead to an unstable subaxial cervical spine and concomitant neurological sequelae. However, no study has evaluated the accuracy of detecting specific facet joint injuries.

Methods: Eight spinal surgeons scored four sets of the same, randomly re-ordered, 30 cases with and without facet joint injuries of the subaxial cervical spine. Two surveys included conventional plain radiographs series (test) and another two surveys included CT scan images (reference). Facet joint injury characteristics were assessed for accuracy and reliability. Raw agreement, Fleiss kappa, Cohen's kappa and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules were used for accuracy analysis.

Results: Of the 21 facet joint injuries discerned on CT scan images, 10 were detected in both plain radiograph surveys (sensitivity, 0.48; 95% confidence interval [CI], 0.26-0.70). There were no false positive facet joint injuries in either of the first two X-ray surveys (specificity, 1.0; 95% CI, 0.63-1.0). Five of the 11 cases with missed injuries had an injury below the lowest visible articulating level on radiographs. CT scan images resulted in superior inter- and intra-rater agreement values for assessing morphologic injury characteristics of facet joint injuries.

Conclusions: Plain radiographs are not accurate, nor reliable for the assessment of facet joint injuries of the subaxial cervical spine. CT scans offer reliable diagnostic information required for the detection and treatment planning of facet joint injuries.

Keywords: Diagnostic imaging; Reproducibility of results; Spinal injuries; Spine; Zygapophyseal joint.