The Early Work-Up for Isolated Ligamentous Injury of the Cervical Spine: Does Computed Tomography Scan Have a Role?

Abstract

HCT is the most sensitive, specific, and cost-effective modality for screening the cervical spine bony injuries, but it is not an effective modality for screening for cervical LI. MRI is clearly superior to HCT for LI. The indications for MRI include abnormalities on HCT, neurologic deficits, cervical pain or tenderness on examination, or the inability to clear the cervical spine in the obtunded patient. With the current state of the art technology, we have redefined the definition of spinal cord injury without radiographic abnormality to include spinal cord injuries without boney injuries or LI.

Flexion and extension radiographic evaluation for the clearance of potential cervical spine injures in trauma patients

“…Several studies have indicated that helical CT alone is sufficient to detect cervical spine injuries [5,18]. Others have recommended the use of MRI acutely to detect ligamentous injuries, as they found that 60 % of flexion extension films are inadequate, consistent with the findings in our patient population [10]. MRI has also been suggested as the next step after CT scanning during the acute evaluation phase, reserving flexion extension studies for clinical follow-up after cervical tenderness subsides [15].…”

Reassessment of the Craniocervical Junction: Normal Values on CT

“…The cost-effectiveness, ability to be performed rapidly, high sensitivity, and specificity make CT the ideal screening tool. 11 As the technology has advanced, we have felt the need to establish normal values on the now widely used MDCT images. The results revealed significant differences between the normal values of commonly used methods to evaluate for AOD on plain radiograph, as reported in the literature and those obtained from our study population on the basis of MDCT images.…”

Anterior Atlantodental and Posterior Atlantodental Intervals on Plain Radiography, Multidetector CT, and MRI

“…MRI shows the spinal cord itself, and the visualization of the cord allows clinicians to determine whether the cord is at risk for, or compressed. MRI can also reveal isolated ligamentous injury, spinal cord contusion, and complex injuries of the occipitoatlantal joint capsule and craniocervical ligaments (16)(17)(18)(19). However, MRI does not permit close cardiovascular monitoring and ventilation support of the traumatized patients during data acquisition (17).…”

“…Recently, the multidetector CT (MDCT) scan has replaced plain radiography as the primary radiological examination type in emergency situations in many hospitals, including our institution. It has been considered the standard modality for the diagnosis of cervical spine injuries (15)(16)(17)(18)(19)(20). More recent studies have claimed that the MRI should be used for complete cervical clearance in all blunt trauma patients (16)(17)(18)(19) A 180-mm field of view (FOV), 512 × 512 matrix, 120 kVp, and 100 mAs were routinely used.…”