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Imaging Occult Lesions in the Cervical Spine Facet Joints

Uhrenholt, Lars PhD, DC*†‡; Nielsen, Edith MD§; Charles, Annie Vesterby DMSc*‡; Hauge, Ellen PhD, MD‡¶; Gregersen, Markil DMSc*

The American Journal of Forensic Medicine and Pathology: June 2009 - Volume 30 - Issue 2 - p 142-147
doi: 10.1097/PAF.0b013e318187de9a
Original Article

Discrete injuries in the lower cervical spine facet joints have been reported in studies of motor vehicle crash victims. We conducted a detailed investigation of these joints from 20 motor vehicle crash fatalities and 22 decedents due to nontraumatic causes, using conventional radiology, computed tomography, and magnetic resonance imaging to examine whether the diagnostic imaging procedures could identify injuries in the facet joints. The diagnostic imaging procedures identified facet joint fractures in 4 of the 19 trauma cases with computed tomography having the highest sensitivity and obtaining good correlation with findings from the microscopical evaluation. No diagnostic imaging procedure could reliably evaluate the integrity of the synovial folds or the joint spaces for bleeding despite microscopical evidence of such findings in these structures in a large proportion of the motor vehicle crash fatalities. This study emphasizes the need for scientific evidence of validity and reliability of advanced diagnostic imaging procedures in forensic settings, in particular, with regard to occult soft tissue lesions, and cautions uncritical use of negative results from these procedures until such evidence has been produced.

From the *Institute of Forensic Medicine, Department of Forensic Pathology, University of Aarhus, Aarhus, Denmark; †Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark; ‡Research Unit for Rheumatology and Bone Biology, Aarhus University Hospital, Aarhus Sygehus (NBG), Aarhus, Denmark; §Departments of Neuroradiology, and ¶Rheumatology, Aarhus University Hospital, Aarhus Sygehus (NBG), Aarhus, Denmark.

Manuscript received July 3, 2007; accepted November 15, 2007.

Supported by grant A.03-5 from the European Chiropractors Union Research Fund, Switzerland, the Foundation for the Advancement of Chiropractic Research, Denmark and the University of Aarhus Research Foundation, Denmark. This study has complied with the national laws on scientific research projects and has been approved by the Scientific Ethics Committee, Aarhus County.

All figures can be viewed in color at

Reprints: Lars Uhrenholt, PhD, DC, Institute of Forensic Medicine, Department of Forensic Pathology, University of Aarhus, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.