Is computed tomography of nonvisualized C7-T1 cost-effective?
The authors determined the cost-effectiveness of computed tomography (CT) of the inadequately visualized C7-T1 level on conventional radiography in a retrospective cohort study. Routine cervical spine radiography was performed in 360 trauma patients in whom the C7-T1 level was not adequately visualized, but there was no evidence of lower cervical spine injury. In these patients, CT of C7-T1 was performed and reviewed for the presence, location, and pattern of fracture. An orthopaedic surgeon was consulted regarding his proposed treatment and the presumed natural history without treatment of each C7-T1 injury identified. Based on Medicare reimbursement data, cost-effectiveness was then calculated for 1) each fracture identified, 2) each fracture that required surgical fixation secondary to risk of further neurologic sequelae (definitely unstable), and 3) each fracture that required either surgical fixation or halo immobilization secondary to the risk of development of cervical instabili