The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation

Jacob D. Gire, Rolando Figueroa Roberto, Matthew Bobinski, Eric Otto Klineberg, Blythe Durbin-Johnson

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background context: Atlantooccipital dislocation (AOD) results in profound patient morbidity and mortality and is difficult to accurately diagnose using current evaluation techniques. Purpose: To evaluate the utility of computed tomography (CT) images in the diagnosis of AOD and compare the revised occipital condyle-C1 interval (CCI) and the condylar sum to the current radiographic criteria used to detect AOD. Study design: Retrospective review to evaluate the sensitivity, specificity, and the interobserver reliability of eight radiographic criteria as applied to CT imaging. Patient sample: Ten cases of clinical AOD and 10 cases of non-AOD cervical injury. Outcome measures: Measured values: revised CCI, Wholey basion-dens interval (BDI), and Harris basion-axis interval (BAI). Calculated values: Sun interspinous ratio, Powers ratio, and condylar sum. Assessment of Lee X-line and atlantooccipital joint asymmetry. Methods: A board certified neuroradiologist, two orthopedic spine surgeons, and two medical students reviewed the CT images for each patient in the series and applied the aforementioned criteria. Results: Average sensitivity between all reviewers for CCI, condylar sum, and atlantooccipital asymmetry was highest at 1.0, 1.0, and 0.96, respectively. Basion-dens interval, X-line, Sun ratio, BAI, and Powers ratio had sensitivities of 0.72, 0.54, 0.32, 0.26, and 0.26, respectively. Revised CCI and condylar sum had significantly better sensitivity than any other test (vs. BDI, p=.014, all others, p<.001) except atlantooccipital asymmetry (p>.99). Specificity for all measurements was 0.78 or greater, except X-line at 0.38. Interobserver reliabilities were the greatest for CCI, condylar sum, atlantooccipital asymmetry, and BDI. Conclusions: The revised CCI (>2.5 mm abnormal) and condylar sum (≥5 mm abnormal) are highly sensitive and reliable radiographic criteria for the detection of AOD when applied to CT imaging.

Original languageEnglish (US)
Pages (from-to)510-519
Number of pages10
JournalSpine Journal
Volume13
Issue number5
DOIs
StatePublished - May 2013

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Tomography
Bone and Bones
Solar System
Medical Students
Spine
Retrospective Studies
Joints
Outcome Assessment (Health Care)
Morbidity
Sensitivity and Specificity
Mortality
Wounds and Injuries

Keywords

  • Atlantooccipital dislocation
  • Condylar sum
  • Condyle-C interval
  • Diagnostic criteria
  • Diagnostic sensitivity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. / Gire, Jacob D.; Roberto, Rolando Figueroa; Bobinski, Matthew; Klineberg, Eric Otto; Durbin-Johnson, Blythe.

In: Spine Journal, Vol. 13, No. 5, 05.2013, p. 510-519.

Research output: Contribution to journalArticle

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abstract = "Background context: Atlantooccipital dislocation (AOD) results in profound patient morbidity and mortality and is difficult to accurately diagnose using current evaluation techniques. Purpose: To evaluate the utility of computed tomography (CT) images in the diagnosis of AOD and compare the revised occipital condyle-C1 interval (CCI) and the condylar sum to the current radiographic criteria used to detect AOD. Study design: Retrospective review to evaluate the sensitivity, specificity, and the interobserver reliability of eight radiographic criteria as applied to CT imaging. Patient sample: Ten cases of clinical AOD and 10 cases of non-AOD cervical injury. Outcome measures: Measured values: revised CCI, Wholey basion-dens interval (BDI), and Harris basion-axis interval (BAI). Calculated values: Sun interspinous ratio, Powers ratio, and condylar sum. Assessment of Lee X-line and atlantooccipital joint asymmetry. Methods: A board certified neuroradiologist, two orthopedic spine surgeons, and two medical students reviewed the CT images for each patient in the series and applied the aforementioned criteria. Results: Average sensitivity between all reviewers for CCI, condylar sum, and atlantooccipital asymmetry was highest at 1.0, 1.0, and 0.96, respectively. Basion-dens interval, X-line, Sun ratio, BAI, and Powers ratio had sensitivities of 0.72, 0.54, 0.32, 0.26, and 0.26, respectively. Revised CCI and condylar sum had significantly better sensitivity than any other test (vs. BDI, p=.014, all others, p<.001) except atlantooccipital asymmetry (p>.99). Specificity for all measurements was 0.78 or greater, except X-line at 0.38. Interobserver reliabilities were the greatest for CCI, condylar sum, atlantooccipital asymmetry, and BDI. Conclusions: The revised CCI (>2.5 mm abnormal) and condylar sum (≥5 mm abnormal) are highly sensitive and reliable radiographic criteria for the detection of AOD when applied to CT imaging.",
keywords = "Atlantooccipital dislocation, Condylar sum, Condyle-C interval, Diagnostic criteria, Diagnostic sensitivity",
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AU - Roberto, Rolando Figueroa

AU - Bobinski, Matthew

AU - Klineberg, Eric Otto

AU - Durbin-Johnson, Blythe

PY - 2013/5

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N2 - Background context: Atlantooccipital dislocation (AOD) results in profound patient morbidity and mortality and is difficult to accurately diagnose using current evaluation techniques. Purpose: To evaluate the utility of computed tomography (CT) images in the diagnosis of AOD and compare the revised occipital condyle-C1 interval (CCI) and the condylar sum to the current radiographic criteria used to detect AOD. Study design: Retrospective review to evaluate the sensitivity, specificity, and the interobserver reliability of eight radiographic criteria as applied to CT imaging. Patient sample: Ten cases of clinical AOD and 10 cases of non-AOD cervical injury. Outcome measures: Measured values: revised CCI, Wholey basion-dens interval (BDI), and Harris basion-axis interval (BAI). Calculated values: Sun interspinous ratio, Powers ratio, and condylar sum. Assessment of Lee X-line and atlantooccipital joint asymmetry. Methods: A board certified neuroradiologist, two orthopedic spine surgeons, and two medical students reviewed the CT images for each patient in the series and applied the aforementioned criteria. Results: Average sensitivity between all reviewers for CCI, condylar sum, and atlantooccipital asymmetry was highest at 1.0, 1.0, and 0.96, respectively. Basion-dens interval, X-line, Sun ratio, BAI, and Powers ratio had sensitivities of 0.72, 0.54, 0.32, 0.26, and 0.26, respectively. Revised CCI and condylar sum had significantly better sensitivity than any other test (vs. BDI, p=.014, all others, p<.001) except atlantooccipital asymmetry (p>.99). Specificity for all measurements was 0.78 or greater, except X-line at 0.38. Interobserver reliabilities were the greatest for CCI, condylar sum, atlantooccipital asymmetry, and BDI. Conclusions: The revised CCI (>2.5 mm abnormal) and condylar sum (≥5 mm abnormal) are highly sensitive and reliable radiographic criteria for the detection of AOD when applied to CT imaging.

AB - Background context: Atlantooccipital dislocation (AOD) results in profound patient morbidity and mortality and is difficult to accurately diagnose using current evaluation techniques. Purpose: To evaluate the utility of computed tomography (CT) images in the diagnosis of AOD and compare the revised occipital condyle-C1 interval (CCI) and the condylar sum to the current radiographic criteria used to detect AOD. Study design: Retrospective review to evaluate the sensitivity, specificity, and the interobserver reliability of eight radiographic criteria as applied to CT imaging. Patient sample: Ten cases of clinical AOD and 10 cases of non-AOD cervical injury. Outcome measures: Measured values: revised CCI, Wholey basion-dens interval (BDI), and Harris basion-axis interval (BAI). Calculated values: Sun interspinous ratio, Powers ratio, and condylar sum. Assessment of Lee X-line and atlantooccipital joint asymmetry. Methods: A board certified neuroradiologist, two orthopedic spine surgeons, and two medical students reviewed the CT images for each patient in the series and applied the aforementioned criteria. Results: Average sensitivity between all reviewers for CCI, condylar sum, and atlantooccipital asymmetry was highest at 1.0, 1.0, and 0.96, respectively. Basion-dens interval, X-line, Sun ratio, BAI, and Powers ratio had sensitivities of 0.72, 0.54, 0.32, 0.26, and 0.26, respectively. Revised CCI and condylar sum had significantly better sensitivity than any other test (vs. BDI, p=.014, all others, p<.001) except atlantooccipital asymmetry (p>.99). Specificity for all measurements was 0.78 or greater, except X-line at 0.38. Interobserver reliabilities were the greatest for CCI, condylar sum, atlantooccipital asymmetry, and BDI. Conclusions: The revised CCI (>2.5 mm abnormal) and condylar sum (≥5 mm abnormal) are highly sensitive and reliable radiographic criteria for the detection of AOD when applied to CT imaging.

KW - Atlantooccipital dislocation

KW - Condylar sum

KW - Condyle-C interval

KW - Diagnostic criteria

KW - Diagnostic sensitivity

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