Post-mortem computed tomography findings of spinal column injuries in comparison to autopsy: A systematic review

Abstract

Accurate identification and evaluation of spinal column injuries in post-mortem settings are crucial for forensic investigations. While traditional autopsies have long been the gold standard, post-mortem computed tomography (PMCT) has emerged as a promising non-invasive and beneficial tool. This systematic review aims to compare the findings of PMCT scans with autopsies in cases of spinal column injuries. Out of 428 articles screened, 11 studies matched the inclusion criteria. PMCT was superior in visualizing fractures in the atlas, axis, and upper cervical spine compared to autopsies. Moreover, PMCT demonstrated efficacy in detecting spinous and transverse process fractures, which are often overlooked in conventional autopsies, but also had limitations in identifying intervertebral injuries and determining the timing of injuries; in addition, the presence of degenerative changes could mask certain fractures. Autopsy demonstrated superiority in detecting dislocations in the craniocervical region and specific types of intervertebral separation. In conclusion, combining both PMCT and autopsy yields more accurate results. Autopsy remains the gold standard, particularly in cases where clearly visualized fractures or injuries are not evident on PMCT scans. Further research and standardization of protocols are warranted to optimize the diagnostic capabilities of both approaches in spinal column injury assessments.