Measurement techniques for upper cervical spine injuries - Consensus statement of the Spine Trauma Study Group

Study Design. Literature review. Objectives. The Spine Trauma Study Group compiled a collection of clinically useful imaging methods used in upper cervical spine trauma and standardized how these measurements are documented. Summary of Background Data. Imaging of the upper cervical spine is crucial for injury detection, description, and treatment decision making. However, a standard set of imaging measurement techniques for this region does not exist. While most clinicians have developed their own methods of describing radiographic pathology, this variability often leads to confusion in developing an agreed on classification system and in proposing universal treatment recommendations. Methods. The available literature concerning measurement of injury characteristics after upper cervical trauma was reviewed. Consensus of the most clinically applicable measurement methods among the surgeon members of the Spine Trauma Study Group was achieved. Results. The techniques include: the basion-dens and basion-posterior axial line intervals (C0-C2); fracture gap and fracture length apposition ( a reflection of fragment size) for occipital condyle injuries; lateral articular overhang for C1 ring fractures; the atlanto-dens and posterior atlanto-dens intervals for sagittal C1-C2 instability; odontoid fracture angulation and displacement; and C2-C3 angulation and translation for traumatic spondylolisthesis of the axis. Conclusions. Only through prospective study using a standardized and uniform set of measurement techniques can the clinical significance of these imaging characteristics be fully appreciated.