1) Understand the role of imaging in cervical spine trauma.
2) Recognize the limitations of depending upon MRI in identification of soft tissue injuries.
3) Appreciate the role MRI may play in assessing the integrity of the spinal cord.
The greatest impact that MRI has made in the evaluation of SCI has been in assessment of the intracanalicular and paraspinal soft tissues. No other imaging modality has been able to faithfully reproduce the internal architecture of the spinal cord and it is this particular feature of MRI that promises to have the largest impact on the management of the SCI patient in the future. The clinical indications for performing an MRI evaluation of the spine in the setting of trauma are controversial and in the absence of a neurologic deficit, the routine use of MRI may be unwarranted. However, MRI has been suggested to be helpful as a problem-solving tool in the acute period for excluding occult ligamentous/soft tissue injury, vertebral thrombosis and for confirmation of bone injury age. Although MRI is a costly screening method, it has also been used to exclude a neurologic injury in uncooperative, obtunded or malingering patients. How rapidly a patient should obtain an MRI is multifactorial and is dependant upon the degree of spinal injury and co-morbidities, stability of the patient, the timing of any intervention and scanner availability. As a result, the use of this expensive modality as a multifaceted screening methodology for spine trauma has grown unchecked over the past decade. There is unequivocal agreement that an MRI examination in the acute period is warranted in any patient who has a persistent neurologic deficit after spinal trauma. In addition, there are a number of novel techniques that are facilitated through MRI (e.g. diffusion tensor imaging) which has the potential to provide added value in gauging prognosis and as a biomarker for assessing future therapies.
Flanders, A,
Controversies in Cervical Spine Trauma. Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL.
http://archive.rsna.org/2011/11001288.html
