Evaluation of cervical spine in intensive care patients following blunt trauma

The aim of this study was to review a Level 1 trauma center's use of early (<72 hours from injury) limited MRI to "clear" cervical spine extradural so ft tissue injuries in ICU patients sustaining blunt trauma. retrospective r eview of the records of patients meeting entry criteria during 1997 was per formed. Demographic data, cervical spine radiographic and imaging evaluatio n, results, and follow-up information were gathered. One hundred and fifty patients met criteria. Forty-one patients had initial static radiographs th at revealed cervical spine trauma. Twenty-seven of the 108 patients with no rmal initial static radiographs had evidence of extradural soft tissue inju ry on MRI indicating potential spinal column instability. Twenty-one of the 108 patients had negative MRI and were liberated from cervical spine preca utions at a mean of 2.9 +/- 0.9 days from injury. The remaining patients we re cleared of cervical spine precautions by plain radiographs and reliable clinical examinations, or by dynamic radiographs, or they died before compl ete evaluation. The diagnosis of acute injury to the cervical spine from bl unt trauma in ICU patients must include evaluation of the osseous spine and extradural soft tissues. Dynamic studies such as flexion and extension vie ws place the obtunded ICU patient at risk of potential neurologic injury. M RI is a noninvasive imaging technique that allows evaluation of extradural soft tissue injury with potentially less patient risk and with fewer person nel. MRI allows early liberation of cervical spine precautions in those pat ients with negative studies. Further studies are needed to compare specific ligamentous injury patterns by MRI with dynamic studies of the C-spine to further define MRI injury patterns indicating risk of acute spinal instabil ity.