title: Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients.
abstract: METHODS
  Radiologic imaging measurement study.
  
  
  OBJECTIVE
  To assess the accuracy of detecting lateral mass and facet joint injuries of the subaxial cervical spine on plain radiographs using computed tomography (CT) scan images as a reference standard; and the integrity of morphological landmarks of the lateral mass and facet joints of the subaxial cervical spine.
  
  
  BACKGROUND
  Injuries of lateral mass and facet joints potentially lead to an unstable subaxial cervical spine and concomitant neurological sequelae. However, no study has evaluated the accuracy of detecting specific facet joint injuries.
  
  
  METHODS
  Eight spinal surgeons scored four sets of the same, randomly re-ordered, 30 cases with and without facet joint injuries of the subaxial cervical spine. Two surveys included conventional plain radiographs series (test) and another two surveys included CT scan images (reference). Facet joint injury characteristics were assessed for accuracy and reliability. Raw agreement, Fleiss kappa, Cohen's kappa and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules were used for accuracy analysis.
  
  
  RESULTS
  Of the 21 facet joint injuries discerned on CT scan images, 10 were detected in both plain radiograph surveys (sensitivity, 0.48; 95% confidence interval [CI], 0.26-0.70). There were no false positive facet joint injuries in either of the first two X-ray surveys (specificity, 1.0; 95% CI, 0.63-1.0). Five of the 11 cases with missed injuries had an injury below the lowest visible articulating level on radiographs. CT scan images resulted in superior inter- and intra-rater agreement values for assessing morphologic injury characteristics of facet joint injuries.
  
  
  CONCLUSIONS
  Plain radiographs are not accurate, nor reliable for the assessment of facet joint injuries of the subaxial cervical spine. CT scans offer reliable diagnostic information required for the detection and treatment planning of facet joint injuries.
authors.affiliation: Stoke Mandeville Spinal Foundation, National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. ; Harris Manchester College, University of Oxford, Oxford, UK.
authors.forename: Joost Johannes
authors.initials: JJ
authors.lastname: van Middendorp
authors.affiliation: Logan Hospital, Logan City, QLD, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Cheung
authors.affiliation: Department of Orthopaedics, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Kristian
authors.initials: K
authors.lastname: Dalzell
authors.affiliation: Department of Orthopaedics, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Hamish
authors.initials: H
authors.lastname: Deverall
authors.affiliation: The Spinal Unit, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia. ; The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Brian J C
authors.initials: BJ
authors.lastname: Freeman
authors.affiliation: Department of Orthopaedics Great Ormond Street Hospital, London, UK.
authors.forename: Stephen A C
authors.initials: SA
authors.lastname: Morris
authors.affiliation: The Spinal Unit, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Simon J I
authors.initials: SJ
authors.lastname: Sandler
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia. ; Trauma Service, Princess Alexandra Hospital, Brisbane, QLD, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.affiliation: The Spinal Unit, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Y H
authors.initials: YH
authors.lastname: Yau
authors.affiliation: AOSpine Reference Centre, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Goss
keywords: Diagnostic imaging; Reproducibility of results; Spinal injuries; Spine; Zygapophyseal joint