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Traumatic cervical spine fracture patterns on CT: a retrospective analysis at a level 1 trauma center

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Abstract

Purpose

The purpose of our study was to determine common acute traumatic cervical spine fracture patterns on CT cervical spine (CTCS).

Methods

We retrospectively reviewed 1091 CTCS positive for traumatic fractures performed over a 10-year period at a level 1 trauma center. Fractures were classified by vertebral level, laterality, and anatomic location (anterior/posterior arch, body, odontoid, pedicle, facet, lateral mass, lamina, spinous process, transverse foramina, and transverse processes).

Results

C2 was the most commonly fractured vertebra (38% of all studies), followed by C7 (32.4%). 48.7% of studies had upper cervical spine (C1 and/or C2) fractures. 39.7% of positive studies involved > 1 vertebral level. Conditioned on fractures at one cervical level, the probability of fracture was greatest at adjacent levels with a 50% chance of sustaining a C7 fracture with C6 fracture. However, 31.3% (136) of studies with multi-level fractures had non-contiguous fractures. The most common isolated vertebral process fracture was of the transverse process, seen in 89 (8.2%) studies at a single level, 27 (2.5%) studies at multiple levels. Subaxial spine vertebral process fractures outnumbered body fractures with progressive dominance of vertebral process fracture down the spine.

Conclusion

C2 was the most commonly fractured vertebral level. Multi-level traumatic cervical spine fractures constituted 40% of our cohort, most commonly at C6/C7 and C1/C2. Although the conditional probability of concurrent fracture in studies with multi-level fractures was greatest in contiguous levels, nearly one-third of multi-level fractures involved non-contiguous fractures.

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Data availability

Our database is accessible to all employees of the tertiary center from which electronic medical records were obtained.

Code availability

Not applicable.

Notes

  1. Using a batch size of 100, reports were manually reviewed for presence of fracture within the impression, followed by standard supervised learning techniques to train a classifier with the true positive/negative results of the batch review. A classification probability for the presence of fracture within the unreviewed reports was generated. The classified, unreviewed reports were subsequently ranked. A new batch for review was selected from reports most likely to contain fractures. The process of manual review improved classifier training, and post-classification ranking was repeated until model accuracy saturated allowing for high fidelity classification of remaining reports. Probability ranked reports were then surfaced for all 36,599 reports.

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Funding

The fracture database for this study was funded by General Electric Healthcare.

Author information

Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Anji Tang & Bharti Khurana

  2. Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, 75 Francis St, Boston, MA, 02115, USA

    Anji Tang & Bharti Khurana

  3. Center for Clinical Data Science, Mass General Brigham, 100 Cambridge St, Boston, MA, 02115, USA

    Jayashri Pawar, Christopher Bridge, Ryan King & Sujay Kakarmath

  4. Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA

    Mitchel Harris

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  1. Anji Tang
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Correspondence to Bharti Khurana.

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Tang, A., Pawar, J., Bridge, C. et al. Traumatic cervical spine fracture patterns on CT: a retrospective analysis at a level 1 trauma center. Emerg Radiol 28, 965–976 (2021). https://doi.org/10.1007/s10140-021-01952-z

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  • DOI: https://doi.org/10.1007/s10140-021-01952-z

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