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 instability and arthritis (potentially or definitely unstable). Eleven of 360 fractures of C7-T1 were identified. The cost-effectiveness of CT for averting potential sequelae was $9,192 for each fracture identified, $16,852 identified for each potentially or definitely unstable fracture identified, and $50,557 for each definitely unstable fracture identified. Computed tomography of the inadequately visualized C7-T1 level on plain radiography is cost-effective, especially given the relatively young age of the trauma population and therefore the high associated morbidity of the sequelae of these injuries over time.