title: Emergency radiology: straightening of the cervical spine in MDCT after trauma--a sign of injury or normal variant?
abstract: OBJECTIVE
  To evaluate whether straightening of the cervical spine (C-spine) alignment after trauma can be considered a significant multidetector CT (MDCT) finding.
  
  
  METHODS
  160 consecutive patients after C-spine trauma admitted to a Level 1 trauma centre received MDCT according to Canadian Cervical Spine Rule and National Emergency X-Radiography Utilization Study indication rule; subgroups with and without cervical collar immobilization (CCI +/-) were compared with a control group (n = 20) of non-traumatized patients. Two independent readers evaluated retrospectively the alignment, determined the absolute rotational angle of the posterior surface of C2 and C7 (ARA C2-7) and grouped the results for lordosis (<-13°), straight (-13 to +6°) and kyphosis (>+6°).
  
  
  RESULTS
  In the two CCI-/CCI+ study groups, the straight or kyphotic alignment significantly (p = 0.001) predominated over lordosis. The number of patients with straight C-spine alignment was higher in the CCI+ group (CCI+ 69% vs CCI- 49%, p = 0.05). A comparison of the CCI+ group vs the CCI- group revealed a slightly smaller number of kyphotic (10% vs 18%, p = 0.34) and lordotic (21% vs 33%, p = 0.33) alignments. Statistically, however, the differences were of no significance. The control group revealed no significant differences.
  
  
  CONCLUSIONS
  Straightening of the C-spine alone is not a definitive sign of injury but is a biomechanical variation due to CCI and neck positioning during MDCT or active patient control.
  
  
  CONCLUSIONS
  Straightening of the C-spine alignment in MDCT alone is not a definitive sign of injury. Straightening of the C-spine alignment is related to neck positioning and active patient control. CCI has a straightening effect on the cervical alignment.
authors.affiliation: 1 Institute for Diagnostic and Interventional Radiology, HELIOS Clinic München West & München Perlach, Munich, Germany.|2 Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Linsenmaier
authors.affiliation: 3 Department of Radiology, University of Latvia, Riga, Latvia.
authors.forename: Zsuszsanna
authors.initials: Z
authors.lastname: Deak
authors.affiliation: 4 Department of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
authors.forename: Aina
authors.initials: A
authors.lastname: Krtakovska
authors.affiliation: 5 European Society of Emergency Radiology (ESER), Vienna, Austria.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ruschi
authors.affiliation: 3 Department of Radiology, University of Latvia, Riga, Latvia.
authors.forename: Nora
authors.initials: N
authors.lastname: Kammer
authors.affiliation: 2 Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany.|3 Department of Radiology, University of Latvia, Riga, Latvia.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirth
authors.affiliation: 3 Department of Radiology, University of Latvia, Riga, Latvia.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.affiliation: 2 Institute for Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany.|3 Department of Radiology, University of Latvia, Riga, Latvia.
authors.forename: Lucas
authors.initials: L
authors.lastname: Geyer
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging; D008141:Lordosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000000981:diagnostic imaging*; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging; D014193:Trauma Centers; D055815:Young Adult