Cervical magnetic resonance imaging abnormalities not predictive of cervical spine instability in traumatically injured patients

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Restricted access

Object. Identifying instability of the cervical spine can be difficult in traumatically injured patients. The goal of this study was to determine whether cervical abnormalities demonstrated on magnetic resonance (MR) imaging are predictive of spinal instability.

Methods. Data in all patients admitted through the Level I trauma service at the authors' institution who had undergone cervical MR imaging were retrospectively reviewed. The reasons for MR imaging screening were neurological deficit, fracture, neck pain, and indeterminate clinical examination (for example, coma). Abnormal soft-tissue (prevertebral or paraspinal) findings on MR imaging were correlated with those revealed on computerized tomography (CT) scanning and plain and dynamic radiography to determine the presence/absence of cervical instability.

Of 6328 patients admitted through the trauma service, 314 underwent MR imaging of the cervical spine. Of 166 patients in whom CT scanning or radiography demonstrated normal findings, 70 had undergone MR imaging that revealed abnormal findings. Of these 70 patients, 23 underwent dynamic imaging, the findings of which were normal. In each case of cervical instability (65 patients) CT, radiographic, and MR imaging studies demonstrated abnormalities. Furthermore, there were 143 patients with abnormal CT or radiographic study findings, in 13 of whom MR imaging revealed normal findings. Six of the latter underwent dynamic testing, which demonstrated normal results.

Conclusions. Magnetic resonance imaging is sensitive to soft-tissue injuries of the cervical spine. When CT scanning and radiography detect no fractures or signs of instability, MR imaging does not help in determining cervical stability and may lead to unnecessary testing when not otherwise indicated.

Article Information

Address reprint requests to: Nicholas Theodore, M.D., Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Representative studies obtained in a 54-year-old man involved in a motor vehicle accident who complained of midline neck tenderness. Upper Left: Sagittal CT scan revealing no signs of acute trauma. Upper Right: Sagittal MR image demonstrating significant soft-tissue injury to the interspinous ligament posteriorly. Lower Left and Right: Flexion (lower left) and extension (lower right) radiographs revealing no signs of cervical subluxation or instability. Flexion and extension swimmer's views showed no instability at the lower cervical and upper thoracic levels (images not shown).

References

1.

Benzel ECHart BLBall PAet al: Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 85:8248291996Benzel EC Hart BL Ball PA et al: Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. J Neurosurg 85:824–829 1996

2.

Cox MWMcCarthy MLemmon Get al: Cervical spine instability: clearance using dynamic fluoroscopy. Curr Surg 58:961002001Cox MW McCarthy M Lemmon G et al: Cervical spine instability: clearance using dynamic fluoroscopy. Curr Surg 58:96–100 2001

3.

D'Alise MDBenzel ECHart BL: Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient. J Neurosurg (Spine 1) 91:54591999D'Alise MD Benzel EC Hart BL: Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient. J Neurosurg (Spine 1) 91:54–59 1999

4.

Flynn JMCloskey RFMahboubi Set al: Role of magnetic resonance imaging in the assessment of pediatric cervical spine injuries. J Pediatr Orthop 22:5735772002Flynn JM Closkey RF Mahboubi S et al: Role of magnetic resonance imaging in the assessment of pediatric cervical spine injuries. J Pediatr Orthop 22:573–577 2002

5.

Frank JBLim CKFlynn JMet al: The efficacy of magnetic resonance imaging in pediatric cervical spine clearance. Spine 27:117611792002Frank JB Lim CK Flynn JM et al: The efficacy of magnetic resonance imaging in pediatric cervical spine clearance. Spine 27:1176–1179 2002

6.

Geck MJYoo SWang JC: Assessment of cervical ligamentous injury in trauma patients using MRI. J Spinal Disord 14:3713772001Geck MJ Yoo S Wang JC: Assessment of cervical ligamentous injury in trauma patients using MRI. J Spinal Disord 14:371–377 2001

7.

Ghanta MKSmith LMPolin RSet al: An analysis of Eastern Association for the Surgery of Trauma practice guidelines for cervical spine evaluation in a series of patients with multiple imaging techniques. Am Surg 68:5635682002Ghanta MK Smith LM Polin RS et al: An analysis of Eastern Association for the Surgery of Trauma practice guidelines for cervical spine evaluation in a series of patients with multiple imaging techniques. Am Surg 68:563–568 2002

8.

Hadley MNApuzzo MLMcCormick P: Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery 50:S36S432002Hadley MN Apuzzo ML McCormick P: Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery 50:S36–S43 2002

9.

Holmes JFMirvis SEPanacek EAet al: Variability in computed tomography and magnetic resonance imaging in patients with cervical spine injuries. J Trauma 53:5245302002Holmes JF Mirvis SE Panacek EA et al: Variability in computed tomography and magnetic resonance imaging in patients with cervical spine injuries. J Trauma 53:524–530 2002

10.

Insko EKGracias VHGupta Ret al: Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. J Trauma 53:4264292002Insko EK Gracias VH Gupta R et al: Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. J Trauma 53:426–429 2002

11.

Katzberg RWBenedetti PFDrake CMet al: Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology 213:2032121999Katzberg RW Benedetti PF Drake CM et al: Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology 213:203–212 1999

12.

Lewis LMDocherty MRuoff BEet al: Flexion-extension views in the evaluation of cervical-spine injuries. Ann Emerg Med 20:1171211991Lewis LM Docherty M Ruoff BE et al: Flexion-extension views in the evaluation of cervical-spine injuries. Ann Emerg Med 20:117–121 1991

13.

Takhtani DMelhem ER: MR imaging in cervical spine trauma. Magn Reson Imaging Clin N Am 8:6156342000Takhtani D Melhem ER: MR imaging in cervical spine trauma. Magn Reson Imaging Clin N Am 8:615–634 2000

14.

Williams RLHardman JALyons K: MR imaging of suspected acute spinal instability. Injury 29:1091131998Williams RL Hardman JA Lyons K: MR imaging of suspected acute spinal instability. Injury 29:109–113 1998

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 85 85 25
Full Text Views 57 57 3
PDF Downloads 74 74 9
EPUB Downloads 0 0 0

PubMed

Google Scholar