Authors: Franck Billmann Therezia BokorBillmann Claude Burnett Erhard Kiffner
Publish Date: 2013/04/24
Volume: 37, Issue: 8, Pages: 1988-1995
Abstract
The odontoid lateral mass interspace OLMI is the space between the lateral aspect of the dens axis and the medial circumference of the massa lateralis atlantis The position of OLMI asymmetry as a normal variant or pathologic finding is an area of debate and clinical interest in trauma patients We designed this prospective study to lay a framework for proposing strategies for the appropriate use of OLMIA total of 301 adult patients admitted for trauma were included Computed tomography CT and magnetic resonance imaging MRI of the cervical spine were performed and examined for the presence OLMI asymmetry and bony/ligamentous lesions of the occipitoatlantoaxial complexHead rotation is linked to the occurrence of OLMI asymmetry Reliable OLMI asymmetry evaluation is limited by observer agreement under a threshold value of 10 mm In all 86 patients 286 were found to have OLMI asymmetry on CT after trauma Among these patients 174 had a bony/ligamentous lesion of the occipitoatlantoaxial complex Among the patients without OLMI asymmetry 88 were found to have such lesionsOLMI asymmetry should only be investigated by CT scans of the head in optimal position and with the threshold value of 10 mm OLMI asymmetry should not be used alone as a sign of a cervical spine lesion MRI should be performed if 1 the physician has a high degree of suspicion of a cervical spine lesion 2 OLMI asymmetry was demonstrated on a technically adequate CT scan 3 clinical symptoms persist in patients with OLMI asymmetry when no acute MRI was performedOur gratitude goes to Professor Ulrich Theodor Hopt Director of the Department for Surgery University Hospital Freiburg im Breisgau for his support The authors thank Marion Racher MD for her advice We also thank anonymous referees for helpful comments
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