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Traditional Threshold for Retropharyngeal Soft-Tissue Swelling Is Poorly Sensitive for the Detection of Cervical Spine Injury on Computed Tomography in Adult Trauma Patients

Hiratzka, Jayme R. MD; Yoo, Jung U. MD; Ko, Jia-Wei MD; Zusman, Natalie L. BS; Anderson, James C. MD; Hiratzka, Shannon L. MPH; Ching, Alexander C. MD

doi: 10.1097/BRS.0b013e31827f0dc3

Study Design. Retrospective cohort study.

Objective. To examine the diagnostic value of prevertebral soft-tissue swelling in the setting of cervical spine trauma.

Summary of Background Data. In adult patients with trauma, an increase in the thickness of the retropharyngeal soft tissues is commonly used as a potential indicator of occult injury, but no studies have examined this parameter using computed tomography (CT) as a screening modality.

Methods. A total of 541 patients with trauma with injuries at any level of the spine underwent CT. Patients with cervical injury were divided into those requiring noninvasive (observation or cervical collar, n = 142) management, and those requiring invasive (surgery or halo, n = 61) treatment. A control group of patients with isolated thoracic or lumbar injuries was used for comparison (n = 542). Retropharyngeal soft tissues were measured at the cranial and caudal endplates of all cervical levels on sagittal and axial CT. Sensitivity and specificity were calculated for +1, +2, and +3 standard deviations from mean values.

Results. Sensitivity for detection of injury was found to be universally poor for all measurement groups. This ranged from 14.4% to 21.2% at +1 SD to 5.3% to 8.7% at +2 SD. Positive and negative predictive values for injury were also universally poor, ranging from 38% to 75%. Soft-tissue swelling as a sentinel sign of cervical spine injury demonstrates consistently high specificity and low sensitivity, precisely the opposite of what would be desired in a screening test. This study shows at best a sensitivity of 21.6% when using this parameter for the detection of these injuries in adult patients with trauma.

Conclusion. On the basis of the results of this study, we recommend against the routine use of measurement of the prevertebral soft tissues on CT as a screening tool for cervical spine injury in adult patients with trauma.

Level of Evidence: 3

Prevertebral soft-tissue swelling is a commonly used parameter when evaluating cervical spine imaging for occult injury. The use of soft-tissue swelling on computed tomographic scan demonstrates poor sensitivity, positive and negative predictive values for the detection of cervical spine injury.

From the Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR

Address correspondence and reprint requests to Alexander C. Ching, MD, OP-31, 3181 SW Sam Jackson Road, Portland, OR 97239; E-mail:

Acknowledgment date: February 6, 2012. First revision date: October 3, 2012. Second revision date: November 9, 2012. Acceptance date: November 14, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, patents, royalties.

© 2013 Lippincott Williams & Wilkins, Inc.