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MRI After Cervical Spine Injury
This study examined a group of consecutive patients with post-traumatic cervical pain. The patients were first screened with spinal x-ray. 174 subjects with equivocal findings on x-ray (e.g., loss of cervical lordosis or questionable alignment abnormalities) and who had significant pain and tenderness, were evaluated with MRI within 72 hours of their injury.
The study reports that 62 (36%) of the patients had soft-tissue abnormalities on MRI. "All abnormalities were thought to be clinically significant, thus warranting further treatment. Significant subaxial MR imaging abnormalities noted were disc interspace disruption in 27 patients (four with ventral and dorsal ligamentous injury, three with ventral ligamentous injury alone, 18 with dorsal ligamentous injury alone, and two without ventral or dorsal ligamentous injury), and isolated ligamentous injury in 35 patients (eight with ventral and dorsal ligamentous injury, five with ventral ligamentous injury alone, and 22 with dorsal ligamentous injury alone)."
The researchers then gave each of these 62 patients with abnormal signs a CT scan, and the CT images only picked up 2 subjects with soft-tissue abnormalities.
"Fifty additional patients (29%) had no evidence of acute soft-tissue injury, but had other potentially significant findings. These were loss of lordosis in 37, significant degenerative changes in 11, and congenital abnormalities in two patients."
The authors found that "T2-weighted sagittal images were most useful acute soft-tissue injury; axial images were of minimal assistance."
The study concludes, "The posttraumatic cervical syndrome (whiplash) is a widespread and costly problem about which little is understood. The information presented here indicates that the MR imaging of findings of paraspinous soft-tissue injury may suggest such an entity. In fact, they may be an imaging correlate of the whiplash syndrome for which the establishment of a clinical/imaging correlation has not been achieved previously. Perhaps a review of early post-injury MR images may provide insight into the etiology, and potentially the management, of persistent posttraumatic neck pain."
Benzel EC, Hart BL, Ball PA, et al. Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. Journal of Neurosurgery 1996;85:824-829.
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