- Screening Cervical Spine CT in the Emergency Department, Phase 2: A Prospective Assessment of Use
Here, the number of unnecessary CT cervical studies despite proper application of NEXUS criteria was assessed. The authors also tried to determine indications for ordering studies in the absence of guideline criteria. Of 507 CT studies, only 5 (1%) were positive while 81 of the 502 patients with negative findings (16%) were imaged despite meeting all NEXUS criteria for non-imaging. The most common indications for the studies were a dangerous mechanism of injury and subjective neck pain. Strict application of NEXUS criteria may result in considerable reduction of screening CT studies of the cervical spine.
- Comparison of MR Imaging Findings between Extraligamentous and Subligamentous Disk Herniations in the Lumbar Spine
Extra- and subligamentous lumbar disk herniations are treated differently. These authors utilized 10 criteria in an attempt to establish the exact location of disk herniations with respect to the posterior longitudinal ligament. Extraligamentous herniations showed: 1) spinal canal compromise of more than half its diameter, 2) internal signal difference in the disk, 3) ill-defined disk margins, 4) disruption of the continuous low-signal-intensity line covering the disk, and 5) presence of an internal dark line in the herniated disk. When combined these 5 yield sensitivity, specificity, accuracy, and an odds ratio of 77.3%, 74.5%, 76.1%, and 9.93, respectively.
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