Should an MR scan be performed routinely after a normal clearance CT scan in the trauma patient? Experience with 59 cases

40-Slice Multidetector CT: Is MRI Still Necessary for Cervical Spine Clearance after Blunt Trauma?

“…16-18, 27, 35, 36 In 2001, Kihiczak et al demonstrated that 10.5 per cent of their patients had MRI findings that were not seen on CS CT; however, none of the patients required operative fixation. 35 The authors suggested that all patients with an unreliable examination should undergo MRI to evaluate the spine. In 2002, Ghanta et al conducted a retrospective evaluation of the Eastern Association for the Surgery of Trauma (EAST) guidelines for cervical spine clearance.…”

Cervical spine clearance in trauma patients

“…Five of the alert patients were managed operatively for unstable ligamentous injury and cord compression. Similarly, in 40 retrospective patients with normal CT findings, Kihiczak et al 62 found that 4 patients had cervical spine injury detected on MRI, two of whom required further management. Oedema of the C5eC6 disc as a result of hyperextension injury was managed in a cervical collar in one case, while another patient had interspinous ligamentous injury of unspecified severity at C5eC7 treated surgically following a period of time in a collar.…”

Magnetic Resonance Imaging (MRI) in the Clearance of the Cervical Spine in Blunt Trauma: A Meta-Analysis

“…Kihiczak et al published similar data in obtunded trauma patients that displayed an incidence of 10.5% bony or ligamentous injury found on MRI when a previous helical cervical spine CT disclosed nothing abnormal. 32 MRI may not prove to be essential in identifying unstable cervical spine injuries requiring surgery, but 82 additional patients had injury identified that could have clinical significance. Allowing for an inherent FP rate of 25% to 40% contained within the 82 injuries, the majority of those patients still have real injuries and received benefit from cervical collar immobilization.…”