We evaluated objective diagnostic methods for patients with possible upper cervical spine instability caused by trauma and correlated them with subsequent neurosurgical findings and outcomes. Between November 1995 and May 1998, we investigated 420 patients with functional magnetic resonance imaging (MRl) ofthe craniocervical junction. We evaluated the extracranial vertebrssiitrculation by MR1 angiography, with focus on the position of the dens and on the subarachnoid space during entire rotational maneuvers. We documented 72 cases (17.1%)

From April 1992 to May 1994, 780 patients aged from 1 day to 8 years were examined. Sedation of these patients was conducted by giving chlorprothixene orally and, in some cases, chloral hydrate had to be added. The patients were monitored with a pulse oxymeter. Investigations could begin after 50 -120 min. In 710 patients (91%) the first attempt to perform the examination was successful; 70 patients required one or two further attempts. Only two of the 780 patients (0.5%) showed evidence of respiratory depression. The total number of pediatric MRI examinations performed in 1 year is almost 1000. In the hands of an experienced pediatric radiologist these examinations can be performed entirely without anesthesia.

The diagnostic utility of imaging techniques in injuries to the intramedullary and subarachnoid portions of the brachial plexus, with possibly complete avulsion of one or more nerve roots from the spinal cord and extramedullary meningocoele was compared in 18 patients studied by unenhanced computed tomography (CT), cervical myelography, myelographic CT (MCT) and magnetic resonance imaging (MRI). Emphasis was placed on the lesions of the subarachnoid roots. CM was the only diagnostic modality to show avulsion of 18 nerve roots and their levels in 8 patients (100% = gold standard), and to verify 2 incomplete avulsions. MCT reliably revealed 8 of 18 (45%) and MRI 1 out of 18 (6%) avulsions. Myelography with MCT showed intact subarachnoid nerve roots in 10 additional patients. MRI and MCT (16 out of 16 = 100%) were superior to myelography (14/16 = 88%) for demonstrating 16 traumatic meningocoeles in 8 patients; follow-up MRI (6-24 months) showed no increase in their size. We recommend a subsequent CT to role out fracture to the spinal column; MRI should provide significant information concerning oedema or haemorrhage in the spinal cord. Myelography with segmental MCT is performed to differentiate pre- from post-ganglionic lesions, data which are essential for deciding whether exploration of the plexus or a motor substitution operation is indicated.