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Original Investigation | Pacific Coast Surgical Association

Clinical Relevance of Magnetic Resonance Imaging in Cervical Spine Clearance:  A Prospective Study

Shelby Resnick, MD1; Kenji Inaba, MD, FRCSC1; Efstathios Karamanos, MD1; Martin Pham, MD2; Saskya Byerly, MD1; Peep Talving, MD, PhD1; Sravanthi Reddy, MD3; Megan Linnebur, MD1; Demetrios Demetriades, MD, PhD1
[+] Author Affiliations
1Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
2Department of Neurosurgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
3Department of Radiology, Los Angeles County + University of Southern California Medical Center, Los Angeles
JAMA Surg. 2014;149(9):934-939. doi:10.1001/jamasurg.2014.867.
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Importance  A missed cervical spine (CS) injury can have devastating consequences. When CS injuries cannot be ruled out clinically using the National Emergency X-Radiography Utilization Study low-risk criteria because of either a neurologic deficit or pain, the optimal imaging modality for CS clearance remains controversial.

Objective  To investigate the accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for CS clearance.

Design, Setting, and Participants  A prospective observational study was conducted from January 1, 2010, through May 31, 2011, at a level I trauma center. Participants included 830 adults who were awake, alert, and able to be examined who experienced blunt trauma with resultant midline CS tenderness and/or neurologic deficits and were undergoing CT of the CS. Initial examinations, all CS imaging results, interventions, and final CS diagnoses were documented. The criterion standard for the sensitivity and specificity calculations was final diagnosis of CS injury at the time of discharge.

Main Outcomes and Measures  Clinically significant CS injuries, defined as injuries requiring surgical stabilization or halo placement.

Results  Overall, 164 CS injuries (19.8%) were diagnosed, and 23 of these (2.8%) were clinically significant. All clinically significant injuries were detected by CT. Fifteen of 681 patients (2.2%) with a normal CT scan had a newly identified finding on MRI; however, none of the injuries required surgical intervention or halo placement. There was no change in management on the basis of MRI findings. The sensitivity and specificity of CT for detecting CS injury was 90.9% and 100%, respectively. For clinically significant CS injuries, the sensitivity was 100% and specificity was 100%.

Conclusions and Relevance  Computed tomography is effective in the detection of clinically significant CS injuries in adults deemed eligible for evaluation who had a neurologic deficit or CS pain. Magnetic resonance imaging does not provide any additional clinically relevant information.

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Final Management and Imaging Results

C-collar indicates cervical collar; CS, cervical spine; CT, computed tomography; and GCS, Glasgow Coma Scale.aInjury diagnosed with magnetic resonance imaging.

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