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Type: Journal article
Title: Detecting facet joint and lateral mass injuries of the subaxial cervical spine in major trauma patients
Author: van Middendorp, J.
Cheung, I.
Dalzell, K.
Deverall, H.
Freeman, B.
Morris, S.
Sandler, S.
Williams, R.
Yau, Y.
Goss, B.
Citation: Asian Spine Journal, 2015; 9(3):327-337
Publisher: Korean Society of Spine Surgery
Issue Date: 2015
ISSN: 1976-1902
Statement of
Joost Johannes van Middendorp, Ian Cheung, Kristian Dalzell, Hamish Deverall, Brian J.C. Freeman, Stephen A.C. Morris, Simon J.I. Sandler, Richard Williams, Y.H. Yau, Ben Goss
Abstract: Study Design: Radiologic imaging measurement study. Purpose: 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. Overview of Literature: 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.
Keywords: Zygapophyseal joint; spine; spinal injuries; diagnostic imaging; reproducibility of results
Rights: Copyright © 2015 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: 10.4184/asj.2015.9.3.327
Appears in Collections:Aurora harvest 3
Orthopaedics and Trauma publications

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