Magnetic resonance imaging cervical spine in trauma: A retrospective single‐centre audit of patient outcomes

Abstract

Objective: Magnetic resonance imaging (MRI) is often used in practice to investigate for cord or discoligamentous injury following blunt trauma and a normal computed tomography (CT). This study investigates the MRI findings and surgical outcomes of patients in this cohort. Methods: Retrospective analysis of patients following trauma with suspected cervical spine injury from 2016 to 2019. Inclusion criteria included patients receiving a normal CT of the cervical spine and subsequent MRI due to cervical spine injury symptomatology (persistent tenderness and/or neurology). Inclusion criteria included: age ≥16 years, alert and <72 h from CT to MRI. Mann-Whitney and χ 2 statistical analysis techniques were employed. Results: Two hundred and twentyeight patients with persistent midline tenderness and/or persistent neurology following blunt trauma and negative CT report were included. One hundred and eighty-one patients received an MRI for persistent tenderness of which 35 revealed abnormal MRI findings. Twenty-one cases required no treatment, 14 cases were treated with a rigid collar with no patients requiring operative management. Forty-seven patients received an MRI for neurological symptoms following blunt trauma and negative CT, with 11 abnormal MRI findings. Management included no treatment (three cases), application of rigid collar (six cases) and operative management (two cases). Conclusion: No alert neurologically intact patient with 'persistent tenderness only' received operative management following a normal CT examination. While MRI is sensitive for detecting soft tissue injuries, the prevalence for detecting clinically significant cervical spine injury in blunt trauma patients in the absence of neurology is low. The utility of MRI in this cohort is questionable considering prolonged spinal immobilisation is not without harm.

Re: Magnetic resonance imaging cervical spine in trauma: A retrospective single‐centre audit of patient outcomes

“…Previous studies have used varying definitions of 'unstable' and 'clinically significant' injuries when reporting on utility of MRI. 5 Ajay MALHOTRA , 1 Xiao WU, 2 Mihir KHUNTE 1 and Mahla RADMARD Response to Re: Magnetic resonance imaging cervical spine in trauma: A retrospective single-centre audit of patient outcomes Dear Editor, The high inter-rater variability reported in our paper was a variable assessing data abstraction. 1 As a retrospective study, the magnetic resonance imaging (MRI) studies were not double read and the inter-rater variability among radiologists in reporting soft tissue findings were not assessed and is a limitation of the study.…”

“…Dear Editor, We would like to commend Foster et al on their recent study showing limited utility of magnetic resonance imaging (MRI) in acute cervical spine trauma following a normal computed tomography (CT) examination. 1 We would like to add a few comments.…”