Efficacy of MRI for assessment of spinal trauma: correlation with intraoperative findings.
METHODS
Observational diagnostic study on consecutive patients.


OBJECTIVE
To assess the efficacy of magnetic resonance imaging (MRI) for detecting spinal soft tissue injury after acute trauma using intraoperative findings as a reference standard.


BACKGROUND
Recognizing injuries to spinal soft tissue structures is critical for proper decision making and management for blunt trauma victims. Although MRI is considered the gold standard for imaging of soft tissues, its ability to identify specific components of soft tissue damage in acute spine trauma patients is poorly documented and controversial.


METHODS
Intraoperative findings were recorded for 21 acute spinal trauma patients (study group) and 14 nontraumatic spinal surgery patients (control group). Preoperative MRI's were evaluated randomly and blindly by 2 neuroradiologists. MRI and intraoperative findings were compared. By using the intraoperative findings as the reference standard, sensitivity, specificity, positive and negative predictive values of MRI in detecting spinal soft tissue injury were determined.


RESULTS
MRI was 100% sensitive and specific in detecting injury to the anterior longitudinal ligament. MRI was moderately sensitive (80%) but highly specific (100%) for injury to the posterior longitudinal ligament. In contrast, MRI was highly sensitive but less specific in detecting injury to paraspinal muscles (100%, 77%), intervertebral disk (100%, 71%), and interspinous ligament (100%, 64%). MRI was moderately sensitive and specific in detecting ligamentum flavum injury (80% and 86.7%) but poorly sensitive for facet capsule injury (62.5%).


CONCLUSIONS
MRI demonstrated high sensitivity for spinal soft tissue injuries. However, MRI showed a definite trend to overestimate interspinous ligament, intervertebral disk, and paraspinal muscle injuries. On the basis of these results, we would consider MRI to be a useful tool for spine clearance after trauma. Conversely, caution should be applied when using MRI for operative decision making due to its less predictable specificity.
Departments of *Orthopedic Surgery, Baylor College of Medicine †Medical Metrics, Houston, TX.
Wu
W
Zhuge
Peleg
P
Ben-Galim
John A
JA
Hipp
Charles A
CA
Reitman
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000293:injuries; D017843:Ligamentum Flavum / Q000293:injuries; D017846:Longitudinal Ligaments / Q000293:injuries*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019637:Orthopedic Procedures / Q000379:methods*; D064170:Paraspinal Muscles / Q000293:injuries; D015203:Reproducibility of Results; D013122:Spinal Diseases / Q000150:complications; D013124:Spinal Injuries / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult