Assessing Spinal Ligamentous Status with MRI

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Assessing Spinal Ligamentous Status with MRI

Specialized dynamic radiographs of the cervical spine, such as flexion and extension lateral radiographs, help physicians diagnose soft-tissue spinal injuries, are inexpensive, and are easily obtained. Yet, in the case of acute trauma, the use of flexion-extension films is controversial for two reasons.

First, the motion necessary to detect instability may not be obtainable due to pain and muscle spasm. Second, if the spine is unstable, it may be inappropriate to take dynamic films. When diagnosing acute trauma, magnetic resonance imaging (MRI) scans may present ligamentous injuries more accurately.
Eighty-nine trauma patients at an emergency department with suspected occult cervical injury were examined using standard radiographs, computed tomography (CT) scans, and MRI scans. Seven patients had ligamentous injury; over half of all injuries resulted from motor-vehicle collisions. MRI scans were successful for assessing the ligamentous status of the cervical spine in all patients, and were the last step in determining treatment. MRI scans showed high sensitivity and a 0% false negative rate.
Conclusion: MRI scans can assess the stability of the spine when radiographs are contraindicated or inconclusive, and can prevent unnecessary immobilization and delayed detection of cervical soft-tissue injuries.
Clinical Note: The authors suggest that when the stability of the cervical spine is questionable and a patient cannot physically have flexion-extension radiographs, MRI is recommended. This allows visualization of nerve tissue for further patient assessment and diagnosis.
Geck MJ, Yoo S, Wang JC. Assessment of cervical ligamentous injury in trauma patients using MRI. Journal of Spinal Disorders 2001:14(5), pp. 371-377.