Publication: Lateral atlantodental interval asymmetry and cervical spine fracture in traumatic brain injury
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Date
2021
Authors
Adnan, Afif Suffian
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Abstract
Introduction: Cervical spine injury is one of the critical injuries due to trauma such as motor vehicle accident (MVA), fall or sport injury. As the injuries to the spine often cause morbidity and sometimes death especially if it occurs at upper cervical spine. The lateral atlantodental interval (LADI) has been usually used for the evaluation of atlanto-axial instability. The LADI is the space between the lateral aspect of the dens axis (C2) and the medial surface of the lateral mass of atlas (C1). However, the sensitivity and specificity of the LADI, in evaluating the instability of the atlanto-axial region is still controversial because LADI asymmetry is occasionally found in patients with a few or no symptoms following trauma, and in healthy patients as well. Some authors believe that this asymmetry may be a normal variant and is unreliable for detecting atlanto-axial instability, while others consider that LADI asymmetry in patients, following trauma, may represent atlanto-axial rotatory subluxation or fixation or fracture. Controversy therefore exists as position of LADI asymmetry is still an area of debate and clinical interest in patients after trauma. Thus, the aim of this study is to determine the association between LADI asymmetry and cervical spine fracture in patient with brain injury following trauma. Methodology: Patients who had brain injury following trauma and proceeded with CT brain and cervical spine were entitled in this study. The LADI was measured using an electronic cursor and ruler on workstation using multiplanar reconstruction images (MPR). The mid-coronal image of the dens was chosen for measuring the parameters. The distance between the lateral aspect of the dens axis (C2) and the medial surface of the lateral mass of atlas (C1) was measured to determine the LADI bilaterally. Mean values, standard deviations, and 95% confidence intervals of the LADI asymmetry were calculated for all the patients. Pearson chi square test was used to correlate the association between LADI asymmetry and cervical fracture. Simple and multiple logistic regression analysis was used to determine an association between age, type of trauma, GCS (glasgow coma scale), gender and race as risk factors in predicting cervical fracture Results: A total of 308 samples were recruited for this study. The result of the data analysis showed that (n=93, 30.19%) patients seen with LADI asymmetry following trauma. Among those 93 patients with LADI asymmetry, only (n=12, 12.9%) associated with cervical fracture. There is no significant association between LADI asymmetry and cervical fracture as the P value > 0.05. However, from the result of logistic regression, some risks factors were significant in predicting the presence of cervical fracture. The age, race and GCS were sigificant risk factors in predicting the presence of cervical fracture with P value < 0.05. Conclusions: In patients with brain injury following trauma, the LADI asymmetry does not have significant association with cervical spine fracture. However few risk factors such age, race and GCS were sigificant in predicting the presence of cervical fracture. Therefore radiologists should be aware of the LADI asymmetry when interpreting CT cervical scans of the atlantoaxial region for presence of cervical fracture in high risks patients.
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Keywords
trauma , brain injury