This 2007 consensus statement from the Spine Trauma Study Group standardizes radiographic measurement techniques for upper cervical spine injuries (C0-C2). It covers occipitocervical dissociation, Jefferson fractures, atlantoaxial instability, odontoid fractures, and Hangman's fractures. The goal is a uniform measurement language to enable multicenter research and consistent treatment decision-making.
Variability in how spine surgeons measured upper cervical injuries was preventing consistent classification, treatment decisions, and meaningful data pooling across institutions. This paper exists to close that gap.
When you pull up a trauma CT on a patient with high-energy cervical injury, use midsagittal CT reconstruction to measure BDI and BAI. Either value above 12 mm is abnormal and indicates occipitocervical dissociation until proven otherwise.
For a Jefferson fracture on plain radiograph, the threshold that matters is 8.1 mm total lateral mass overhang (Heller), not the 6.9 mm Spence cadaveric number. The difference exists because plain films magnify displacement. On CT, measure directly.
For odontoid fractures, displacement above 5-6 mm elevates nonunion risk and should factor into your operative versus nonoperative discussion. For Hangman's fractures, you cannot classify type II versus IIa without measuring angulation and translation at C2-C3 — the endorsed method uses posterior vertebral body tangent lines.
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This 2007 consensus statement from the Spine Trauma Study Group standardizes radiographic measurement techniques for upper cervical spine injuries (C0-C2). It covers occipitocervical dissociation, Jefferson fractures, atlantoaxial instability, odontoid fractures, and Hangman's fractures. The goal is a uniform measurement language to enable multicenter research and consistent treatment decision-making.
Variability in how spine surgeons measured upper cervical injuries was preventing consistent classification, treatment decisions, and meaningful data pooling across institutions. This paper exists to close that gap.
When you pull up a trauma CT on a patient with high-energy cervical injury, use midsagittal CT reconstruction to measure BDI and BAI. Either value above 12 mm is abnormal and indicates occipitocervical dissociation until proven otherwise.
For a Jefferson fracture on plain radiograph, the threshold that matters is 8.1 mm total lateral mass overhang (Heller), not the 6.9 mm Spence cadaveric number. The difference exists because plain films magnify displacement. On CT, measure directly.
For odontoid fractures, displacement above 5-6 mm elevates nonunion risk and should factor into your operative versus nonoperative discussion. For Hangman's fractures, you cannot classify type II versus IIa without measuring angulation and translation at C2-C3 — the endorsed method uses posterior vertebral body tangent lines.