Cervical Spine Clearance in the Traumatically Injured Patient: Is CT Scan Sufficient Alone

Brandon Chew, MD1, Matthew Quigley, MD1, Chris Swartz1

1Pittsburgh, PA United States

Keywords: cervical spine, computed tomography, trauma, spinal cord injury, pain

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     Clearance of the cervical spine in the trauma patient remains a contentious issue.
     Although some have advocated for the use of CT scanning alone, this has been criticized, among other things, for the absence of a gold-standard comparator- namely MR.
     There were 1004 patients reviewed, of which 614 were male, average age overall of 47 years. Thirty-nine patients ultimately underwent (29 anterior/10 posterior) cervical surgical procedures (5 delayed), for central cord syndrome (21), quadraparesis (9) or discogenic radicular pain (9). None had an unstable spine.
     A retrospective review of a prospectively collected trauma database for all patients admitted 1/04-1/11 to a level one trauma center who had a cervical CT interpreted by a board certified radiologist, as being without evidence of acute traumatic injury and a cervical MR obtained during the same hospital admission.
     The MR was interpreted as normal in 645, evidencing ligamentous injury alone in 125 and showing non-specific degenerative changes in the rest. Of the 125 ligamentous injuries, 59 had documentation of clearance (22 clinical, 37 with F/E X-rays), 5 died prior to clearance and one was transferred to another facility prior to clearance. No patient with ligamentous injury on MR was documented to require any surgical procedure nor orthosis.
     This is a retrospective study.
     In this large population of traumatically injured patients with normal cervical CT scans, MR was useful solely to guide surgical procedures already determined by clinical presentation.
     The appearance of ligamentous injury alone on MR was a common occurrence (12.5%) but never predicted occult cervical instability.


Project Roles:

B. Chew (), M. Quigley (), C. Swartz ()