Clinical Research Details

Clinical Research

Acute trauma with ligamentous injury to the craniocervical junction and tectorial membrane in adult and pediatric patients

Study Description

The purpose of this study is to further characterize acute traumatic injuries of ligamentous and bony components of the cervical spine incurred during acute trauma. The imaging data will be analyzed with respect to clinical outcome in pediatric and adult patients. As a level one trauma center, the UF Health department of radiology is in a unique position to perform this study. These injuries are often underreported due to being incompletely described in the literature, which this study proposes to augment in the form of a research article. Tectorial membrane (TM) injuries are uncommon findings in the setting of head and neck trauma and often occur in the setting of a high speed injury, mainly related to motor vehicle accidents. In the adult population, TM injury often accompanies other post traumatic craniocervical junction (CCJ) injuries, including injuries to other stabilizing ligaments, with often more devastating clinical outcomes for the patient. Previous studies have demonstrated that TM injuries in the pediatric population often accompany retroclival epidural hematomas (REH), may occur less frequently with other CCJ ligamentous injuries, and also may be an isolated finding. Computed tomography (CT) imaging is the study of choice to examine the CCJ for bony injuries such as subluxation and fracture. Ligamentous injuries to the TM and other CCJ ligaments may be inferred if there is a bony abnormality on cervical spine x-ray or CT, however they may go undetected using these modalities. Magnetic resonance imaging (MRI), which is known to image soft-tissue structures with greater precision, may be utilized to better define injuries to the CCJ and cervical cord. As MRI technology advances, increased magnetic field strength has allowed for more accurate visualization of the TM and CCJ ligamentous structures. A retrospective analysis of the CT/MRI exams of patients with TM injuries will be undertaken in order to better define the imaging features of TM injury in the adult and pediatric populations. Furthermore, the frequency of REH and other CCJ ligamentous damage in the setting of TM injury will be assessed. Additionally, the imaging findings of TM injuries will be compared between adult and pediatric populations to evaluate key differences and similarities. Finally, the clinical presentation, management, and outcomes of patients with TM injury will be analyzed.

Inclusion criteria: - suffered traumatic injury - received neuroimaging to include MRI/CT - determined to have injury to tectorial membrane or craniocervical junction by radiologist Exclusion criteria: - no traumatic injury to craniocervical ligaments or tectorial membrane The data will be obtained using a montage search for patients who have identifiers of 'craniocervical junction' or 'tectorial membrane' injuries in their radiology reports over the last several years. The two sources of data will be the Epic EMR for clinical history and the results of the imaging studies from Visage. The images will be analyzed by three independent neuroradiologists and discrepancies will be resolved by consensus. The findings will be entered into an excel spreadsheet. The only identifying information in this spreadsheet will be MRN and age. No patient names or any other identifying information will ever be recorded. The clinical history will be obtained from retrospective chart review and entered into the excel spreadsheet as well. Once all required information is in the excel spreadsheet, the column containing patient MRN will be deleted, thus effectively de-identifying all patient data and anonymizing it. Data analysis will be performed after all data is gathered and de-identified. Imaging characteristics, clinical presentation, management, and outcomes will be compared between adult and pediatric patients. The hypotheses that pediatric patients have a higher incidence of retroclival epidural hemorrhage and isolated tectorial membrane injury and are more likely to undergo conservative management with better outcomes will be tested by comparing the two groups of patients. Adult patients are hypothesized to have higher incidence of associated injuries to the craniocervical junction ligaments and are likely to undergo surgical management with worse outcome. This will be tested by performing statistical analysis on the de-identified patient data and will be reported in the form of a research article. Statistical significance may not be achieved due to the rarity of this injury, however it will not be necessary for publication of these findings to benefit the scientific community at large. The manuscript will detail the subtleties of imaging findings of this under reported and potentially devastating condition.


Principal Investigator
Peter J. Fiester, M.D.

Sub Investigator
Marie L. Crandall, M.D., M.P.H., FACS

Sub Investigator
Patrick E. Natter, M.D.

Sub Investigator
Gazanfar Rahmathulla, M.B.B.S. (M.D.)