Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Confirmation of cervical spine stability is difficult to obtain in the comatose or obtunded trauma patient. Concurrent therapies such as endotracheal intubation and the application of rigid cervical collars diminish the utility of plain radiographs. Bony as well as supportive soft-tissue structures must be evaluated before the cervical spine can be determined to be uninjured. Although major injuries to extradural soft-tissue structures in the awake trauma patient are frequently excluded by physical examination, when the patient is obtunded the physical examination may be unreliable. Therefore, an enhanced diagnostic method for the evaluation of soft-tissue injury is desirable. The authors conducted a study in which magnetic resonance (MR) imaging was used as such a method to assess posttraumatic spinal stability in the comatose or obtunded patient.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> Early, limited (sagittal T<jats:sub>1</jats:sub>- and T<jats:sub>2</jats:sub>-weighted) MR imaging was performed posttruama in 121 patients to assess soft-tissue injury. In all patients the mechanism of injury potentially could be associated with cervical spine instability, and each patient was endotracheally intubated because of head injury or severe multisystem injuries. All patients underwent imaging studies within 48 hours of injury and were either treated or cleared and spinal precautions were discontinued. Patients were excluded from this study if they had an obvious cervical spine injury identified on the initial radiographic studies or if they were determined to be too medically unstable to undergo MR imaging within the acute period (&lt;48 hours postinjury).</jats:p> <jats:p content-type="fine-print">Thirty-one (25.6%) of the 121 patients were found to have sustained significant injury to the paravertebral ligamentous structures, the disc interspace, or the bony cervical spine. These injuries were undetected by plain radiography. The other 90 patients (74.4%) were determined within 48 hours not to have sustained a soft-tissue injury. Eight patients (6.6%) ultimately underwent surgery to treat the cervical spine injury, and MR imaging was the first test that identified the injury in each of these patients. There were no complications related to imaging procedures.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Sagittal T<jats:sub>1</jats:sub>- and T<jats:sub>2</jats:sub>-weighted MR imaging appears to be a safe, reliable method for evaluating the cervical spine for nonapparent injury in comatose or obtunded trauma patients. In the early postinjury period, nursing and medical care are thereby facilitated for patients in whom occult injury to the spine is ruled out and for whom those attendant precautions are unnecessary.</jats:p>

Correlation of Qualitative and Quantitative M RI Parameters with Neurological Status: A Prospective Study on Patients with Spinal Trauma

“…Other studies [3,8,9] have also reported a similar trend. India is a developing country with increasing vehicular traffic and poorly maintained roads, especially in rural areas.…”

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

“…D'Alise et al [164] examined unconscious patients who had undergone tracheal intubation and showed that 25.6% suffered injury to bone, disc, or paravetebral ligaments not seen on plain films, although CT revealed 10.7% of fractures. Albrecht et al [165] examined 150 trauma victims in intensive care and found that 27 (25.0%) had MRI abnormalities despite normal plain films and ⁄ or CT. Benzel et al [166] further evaluated 174 patients in whom clinical evaluation or plain films had indicated injury; MRI revealed ligamentous injury in 35 (20.1%) of these cases.…”

“…In these studies, only 223 patients were 'cleared' by MRI [164][165][166]; follow-up details are incomplete, and despite normal imaging, patients remained in collars until they could be assessed clinically [165]. Evaluating abnormalities seen on plain films or CT, it has been suggested MRI can reliably predict stability but numbers are again small and injuries highly specific, i.e.…”

Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection?

“…Clearing the cervical spine following institutional protocol did not initially detect the severity of instability in 11 % of injuries in the present study. In light of its ability to detect ligamentous and soft tissue lesions and osseous edema, MRI is accepted as the most reliable imaging modality for discoligamentous injuries with a reported negative predictive value of up to 100 % [20][21][22][23], thus precluding unstable discoligamentous injuries [20,21,24]. The false-negative rate for secondary MRI to detect discoligamentous injuries where the initial CT scan was negative was reported to be up to 25 % [8-10, 24, 25].…”