MAGNETIC-RESONANCE-IMAGING FOR THE EVALUATION OF PATIENTS WITH OCCULTCERVICAL-SPINE INJURY

Because it is often difficult to diagnose accurately the structurally intact cervical spine after acute trauma, a series of patients was eva luated with magnetic resonance (MR) imaging to assess its efficacy for the evaluation and clearance of the cervical spine in a trauma victim in the early posttrauma period. Ultralow-field MR imaging was used to evaluate 174 post-traumatic patients in whom physical findings indica ted the potential for spine injury or minor radiographic findings indi cated injury. This series includes only those patients who did not app ear to harbor disruption of spinal integrity on the basis of a routine x-ray film. None had clinically obvious injury. Of the 174 patients, 62 (36%) had soft-tissue abnormalities identified by MR imaging, inclu ding disc interspace disruption in 27 patients (four with ventral and dorsal ligamentous injury, three with ventral ligamentous injury alone , 18 with dorsal ligamentous injury alone, and two without ventral or dorsal ligamentous injury). Isolated ligamentous injury was observed i n 35 patients (eight with ventral and dorsal ligamentous injury, five with ventral ligamentous injury alone, and 22 with dorsal ligamentous injury alone). One patient underwent a surgical fusion procedure, 35 p atients (including the one treated surgically) were placed in cervical collar for at least 1 month, and 27 patients were placed in a thermop lastic Minerva jacket for at least 2 months. All had a satisfactory ou tcome without evidence of instability. The T-2-weighted sagittal image s were most useful in defining acute soft-tissue injury; axial images were of minimal assistance. Posttraumatic soft-tissue cervical spine i njuries and disc herniations (most likely preexisting the trauma) are more common than expected. A negative MR image should be considered as confirmation of a negative of ''cleared'' subaxial cervical spine. Di agnostic and patient management algorithms may be appropriately tailor ed by this information. Thus, MR imaging is useful for early acute pos ttrauma assessment in a very select group of patients.