title: MRI as an adjunct to cervical spine clearance: a utility analysis.
abstract: Cervical spine (CS) injury occurs in 1 to 3 per cent of blunt trauma patients. The goal of this study is to evaluate the use of magnetic resonance imaging (MRI) as an adjunct to CS computed tomography (CT) in the presence of persistent pain with a normal physical examination or obtundation.  A retrospective chart review was performed on 389 blunt trauma patients undergoing both CS CT and MRI between 2007 and 2010. Abnormal CT findings were found in 199. The remaining 190 patients with normal CT scans underwent MRI for persistent pain (109), neurologic symptoms (57), or obtundation  (24). Motor vehicle crashes predominated (50%) followed by falls (19%) and motorcycle crashes (12%). In the patients with persistent pain, CT showed no acute injury (89%) with subsequent MRI demonstrating ligamentous edema or injury not seen on CT in 12 per cent of patients. No patient required  an operation for CS instability. All the obtunded patients demonstrated localizing motion of four extremities. MRI of these patients demonstrated ligamentous edema or injury not seen on CT in 20 per cent of patients. No obtunded patient had CS instability or needed operative intervention.  A localizing physical examination in conjunction with normal CS CT safely precludes a CS injury requiring cervical fixation. MRI does not add substantially to this decision-making and the cervical collar can be safely removed.
authors: Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors: Michael C
authors: MC
authors: Soult
authors: Leonard J
authors: LJ
authors: Weireter
authors: Rebecca C
authors: RC
authors: Britt
authors: Jay N
authors: JN
authors: Collins
authors: Timothy J
authors: TJ
authors: Novosel
authors: Scott F
authors: SF
authors: Reed
authors: L D
authors: LD
authors: Britt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012042:Registries; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D055815:Young Adult