Magnetic resonance imaging does not provide any additional clinically relevant information

A missed cervical spine (CS) injury can have devastating consequences. When CS injuries cannot be ruled out clinically using the National Emergency X-Radiography Utilization Study low-risk criteria because of either a neurologic deficit or pain, the optimal imaging modality for CS clearance remains controversial.

Cervical spine injury complicates the care of approximately 4% of injured patients admitted to trauma centers across the United States.

Evaluation

The initial evaluation of patients for cervical spine injury involves a detailed physical examination with careful evaluation of the criteria to determine whether radiographic evaluation of the cervical spine is necessary.

Radiographic evaluation

Once screening the cervical spine with radiography has been determined necessary, plain radiography has traditionally been the initial screening test for patients at risk of cervical spine injury.

Realization that standard cervical spine radiography fails to identify all patients with cervical spine injuries has resulted in the use of additional radiographic studies including supine oblique views, flexion-extension radiographs, or computed tomography (CT) scanning.

Cervical spine CT scanning

Computed tomography is effective in the detection of clinically significant CS injuries in adults deemed eligible for evaluation who had a neurologic deficit or CS pain.

Is being utilized with increasing frequency as a screening test for patients with potential cervical spine injury. However, the appropriate screening test to rule out cervical spine injury in the blunt trauma patient is unclear.

Magnetic resonance imaging

Magnetic resonance imaging does not provide any additional clinically relevant information 1).

1) Resnick S, Inaba K, Karamanos E, Pham M, Byerly S, Talving P, Reddy S, Linnebur M, Demetriades D. Clinical Relevance of Magnetic Resonance Imaging in Cervical Spine Clearance: A Prospective Study. JAMA Surg. 2014 Jul 30. doi: 10.1001/jamasurg.2014.867. [Epub ahead of print] PubMed PMID: 25076462.

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