Abstract
Introduction
Magnetic resonance imaging (MRI) is a vital tool for detection of instability and soft tissue trauma following cervical spine injuries (CSIs). However, high cost, prolonged imaging time, and limited use in hemodynamically unstable patients necessitates that the utility of MRI on all CSI patients be scrutinized.
Methods
A retrospective review was performed of all patients treated for a CSI at a level I trauma center between 2005 and 2010. Patients were identified using CT imaging and a subgroup underwent MRI. Adjacent level ligamentous injury (ALLI) was defined as supraspinous and interspinous ligaments and classified concerning the fracture level. We identified correlations between fracture type, level, and treatment strategy to develop guidelines for necessary MRI use.
Results
MRI was performed on 240/787 patients. Evidence of soft tissue injury was identified in 54.6% of these patients. ALLI was the most common soft tissue injury occurring in 80/240 of cases, which were then subdivided to either above (31/80), below (31/80) or both above and below (18/80) the concurrent fracture level. Patients with ALLI were significantly more likely to have injured C3 (p < 0.01) and C5 (p < 0.03), and present in association with widened disc space (13 vs. 4%, p = 0.03) and multiple CSI (1.7 vs. 1.5, p = 0.008). None of the patients who presented with ALLI above and below, and underwent surgical fixation, had the whole ALLI levels included in the fixation strategy. Contrary, 100 and 87% of patients with ALLI only above and only below, respectively, had the whole ALLI included.
Conclusions
MRI found an associated soft tissue injury in only 50% of imaged patients. Multiple fractured cervical levels, fractures particularly at C3 and C5, and widened disc space should all raise the treating physician's level of suspicion for ALLI. Our data shows MRI-directed treatment has substantial value in a select group of patients.