Is computed tomography of nonvisualized C7-T1 cost-effective?

The authors determined the cost-effectiveness of computed tomography (CT) o f the inadequately visualized C7-T1 level on conventional radiography in a retrospective cohort: study. Routine cervical spine radiography was perform ed in 360 trauma patients in whom the C7-T1 level was nor adequately visual ized, but there was no evidence of lower cervical spine injury. In these pa tients, 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 e ach C7-T1 injury identified. Based on Medicare reimbursement data, cost-eff ectiveness was then calculated for 1) each fracture identified, 2) each fra cture that required surgical fixation secondary to risk of further neurolog ic sequelae (definitely unstable), and 3) each fracture that required eithe r surgical Fixation or halo immobilization secondary to the risk of develop ment of cervical instability and arthritis (potentially or definitely unsta ble). Eleven of 360 fractures of C7-T1 were identified. The cost-effectiven ess of CT for averting potential sequelae was $9,192 for each fracture iden tified, $16,852 identified for each potentially or definitely unstable frac ture identified, and $50,557 for each definitely unstable fracture identifi ed. Computed tomography of the inadequately visualized C7-T1 level on plain radiography is cost-effective, especially given the relatively young age o f the trauma population and therefore the high associated morbidity of the sequelae of these injuries over time.