title: The role of magnetic resonance imaging in acute cervical spine fractures.
abstract: BACKGROUND
  The role of magnetic resonance imaging (MRI) in neurologically intact cervical spine fractures is not well defined. To our knowledge, there are no studies that clearly identify the indications for MRI in this particular scenario. Controversy remains regarding the use of MRI in at-risk patients, primarily the obtunded and elderly patients.
  
  
  OBJECTIVE
  The purpose of the present study was to examine the predisposing conditions where an MRI would provide additional findings that would affect management in acute cervical spine fractures.
  
  
  METHODS
  Retrospective cohort involving radiographic and clinical review.
  
  
  METHODS
  Consecutive patients with acute cervical injuries at a single institution.
  
  
  METHODS
  Neurologic recovery.
  
  
  METHODS
  A review of 830 patients with cervical spinal injuries between 2006 and 2010 was performed. Clinical information was obtained for all the patients: Glasgow Coma Scale, mechanism of injury, major medical comorbidities, associated injuries, neurologic examination, neurologic symptoms, sex, age, and alertness. Two experienced fellowship-trained spine surgeons determined if the MRI study changed the management in the individual cases based on the Sub-axial Cervical Spine Injury classification system.
  
  
  RESULTS
  Ninety-nine patients with a cervical fracture were included in the final analysis: median age 54 years (interquartile range, 42 years), mean Glasgow Coma Scale 13 (standard deviation ± 3.0), 68% males, 32% females, 42% older patients (age>60 years), 30% spondylosis, 27% polytrauma, 67% alert, 28% neurologic deficit. Major medical comorbidities, prior to injury level of activity, atlantoaxial versus subaxial, and gender were not associated with changes in diagnosis and management (p>.05). Age >60 years, neurologic deficit, polytrauma status, alertness, and spondylosis were associated with having additional clinically relevant findings seen on MRI and changes in management (p<.05). The majority of the changes in management were related to MRI's illustration of the spinal cord injury and not due to an occult instability. Eighty-one percent of the changes in management were related to the depiction of the spinal cord compression seen on MRI, whereas 19% of the changes in management were related to occult instability seen on MRI.
  
  
  CONCLUSIONS
  Older age (>60 years), obtunded or temporary non-assessable status, cervical spondylosis, polytrauma, and neurologic deficit are predisposing factors for further injury found on MRI but missed on computed tomographic scan alone. These additional findings can affect the management in acute cervical spine fractures. The rational of the on-call spine surgeon to order an MRI for a cervical spine fracture is well founded and often that MRI will affect the fracture management. Magnetic resonance imaging particularly helps with better defining the type of spinal cord compression. Picking up occult instability missed on computed tomographic scan was possible with MRI but not as common.
authors.affiliation: Department of Orthopedic Surgery, Seton Hall University-St Joseph's Regional Medical Center, 703 Main St, Paterson, NJ 07503, USA. Electronic address: spourtah@gmail.com.
authors.forename: Sina
authors.initials: S
authors.lastname: Pourtaheri
authors.affiliation: Department of Orthopedic Surgery, Seton Hall University-St Joseph's Regional Medical Center, 703 Main St, Paterson, NJ 07503, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Emami
authors.affiliation: Department of Orthopedic Surgery, Seton Hall University-St Joseph's Regional Medical Center, 703 Main St, Paterson, NJ 07503, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Sinha
authors.affiliation: Department of Orthopedic Surgery, Seton Hall University-St Joseph's Regional Medical Center, 703 Main St, Paterson, NJ 07503, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Faloon
authors.affiliation: Department of Orthopedic Surgery, Seton Hall University-St Joseph's Regional Medical Center, 703 Main St, Paterson, NJ 07503, USA.
authors.forename: Ki
authors.initials: K
authors.lastname: Hwang
authors.affiliation: Department of Orthopedic Surgery, Seton Hall University-St Joseph's Regional Medical Center, 703 Main St, Paterson, NJ 07503, USA.
authors.forename: Eiman
authors.initials: E
authors.lastname: Shafa
authors.affiliation: Department of Orthopedic Surgery, Nemours/Alfred I. DuPont Children's Hospital, 1600 Rockland Rd, Wilmington, DE 19803, USA.
authors.forename: Laurens
authors.initials: L
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011859:Radiography; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D055815:Young Adult
keywords: Alert; Cervical spine; Elderly; Fracture; MRI; Neurologic deficit