Recommendation 9: Summary of included studies comparing imaging in the assessment of the cervical spine
| Article year, (reference) | No. of subjects | Cervical spine imaging modality | Parameter assessed | Outcome |
|---|---|---|---|---|
| 1989108 | 55 | CR (AP, lateral F/E, OM) | Atlanto-axial lesions Atlanto-occipital lesions Odontoid lesions Odontoid fibro-ostosis | Atlanto-axial lesions: CR = CT > MRI Atlanto-occipital lesions: CR = CT > MRI Odontoid lesions: MRI > CR/CT Odontoid fibro-ostosis: CR = CT > MRI |
| MRI | ||||
| CT | ||||
| 2000109 | 5 known AAS | CR (F/E) | AAS | More detail seen with MRI, and using F/E views |
| MRI (F/E) | ||||
| 2005110 | 31 | CR (F/E) | ADI Dense erosions | CR showed greater ADI in flexion than MRI, p 0.001 No significant difference in neutral/extension Assessment of dens erosions easier with MRI |
| MRI (F/E) | ||||
| 1998111 | 65 unstable AAS | CR (lateral N/ F/E) | AAS | Significant difference between AAS in neutral and flexion/extension, p <0.0001 |
| 1998112 | 28 symptomatic | CR (AP, lateral N/F, OM) | AAS Odontoid erosions/cysts | Combination on MRI with CR showed more involvement than CT with CR (1.25-fold more VS; 1.13-fold more erosions/cysts) |
| MRI | ||||
| CT | ||||
| 2000113 | 42 symptomatic | MRI (N/F) | Reduction in subarachnoid space | Flexion views showed more: brainstem compression (1.17-fold) reduction in the subarachnoid space at the atlanto-axial level (1.06-fold) and below C2 (1.13-fold) |
| Brainstem compression | ||||
| 2000114 | 25 | CR (AP, lateral F/E, OM) | Odontoid erosions | Lateral views showed more erosions (1.57-fold) than open mouth views |
| 2011115 | 56 symptomatic | CR (lateral) | CT factors predictive of VS on CR | VS greater in presence of odontoid erosions, p<0.05 Odontoid erosions significantly associated with odontoid osteoporosis, p<0.05 |
| CT | ||||
| 1995116 | 136 symptomatic | CR (AP, lateral F/E) | MRI findings in normal CR | All MRI abnormal with normal CR: Effusion: 28% Pannus: 62% |
| MRI | ||||
| 2009117 | 40 | CR (lateral N/ F/E, OM) | AAS Dens erosions | % patients with C-spine involvement on: CR 47.5%, MRI 70%, CT 28.2% Anterior AAS seen more in flexion on CR than MRI, p<0.005 CT best at detecting lateral AAS Dens erosions: CR 12.5%, MRI 67.5%, CT 41% |
| MRI (N/F/E) | ||||
| CT | ||||
| 2011118 | 267 | CR (lateral N/F/E) | Baseline features predictive of VS and SAS at 5 years | Prediction of VS: AAS, p 0.01; VS, p<0.01; SAS, p 0.06 Prediction of SAS: AAS, p 0.29; VS, p<0.01; SAS, p<0.01 |
| 1987119 | 18 symptomatic | CR (AP, lateral F/E) | AAS CS SAS Dens erosions | MRI vs CR: AAS: 0.88-fold CS: 1.0-fold SAS: 0.5-fold Dens erosions: 1.27-fold |
| MRI | ||||
| 2001120 | 46 symptomatic | CR (lateral N/F, OM) | Baseline CR and MRI features predictive of clinical neurological dysfunction at 1 year | CR not predictive (odontoid erosions, AAS) Dysfunction according to MRI (OR): Dens erosion: 1.5; atlas erosion: 4.9 Decreased subarachnoid space: 12.0 Decreased atlanto-axial space: 2.4 Brainstem compression: 2.3 |
| MRI |
AAS, atlantoaxial subluxation; ADI, atlanto-dental interval; AP, anteroposterior; CR, conventional radiography; CS, craniovertebral settling; E, extension; F, flexion; N, neutral; OM, open mouth; SAS, subaxial subluxations; VS, vertical subluxations.