Magnetic Resonance Imaging Is Not Needed to Clear Cervical Spines in Blunt Trauma Patients With Normal Computed Tomographic Results and No Motor Deficits

Arch Surg. 2005 Aug;140(8):762-6. doi: 10.1001/archsurg.140.8.762.

Abstract

Hypothesis: Trauma patients with normal motor examination results and normal cervical spine helical computed tomographic (CT) scans with sagittal reconstructions do not have significant cervical spine injury.

Design: Prospectively collected registry data.

Setting: Level II community-based trauma center.

Patients: All patients admitted to the trauma service from January 1, 1999, to December 31, 2003.

Main outcome measures: Injury detected by CT and/or magnetic resonance imaging (MRI) of the cervical spine. Neurologic examination and need for surgery were secondary outcomes.

Results: During the study period, 2854 trauma patients were admitted, of whom 91.2% had blunt trauma. Of these patients, 56.2% had a closed head injury. One hundred patients had cervical spine and/or spinal cord injuries. Eighty-five patients had a cervical spine injury diagnosed by CT. Fifteen patients had admission neurologic deficits not seen on CT, and 7 of these patients had non-bony abnormalities on MRI. Ninety-three patients had a normal admission motor examination result, a CT result negative for trauma, and persistent cervical spine pain, and were examined with MRI. All MRI examination results were negative for clinically significant injury. Seventeen patients had MRIs that showed degenerative disc disease, and 6 had spinal canal stenosis secondary to ossification. Twelve comatose patients (Glasgow Coma Scale score, <9), moving all 4 extremities on arrival, with normal CT results of the cervical spine, were examined with MRI. All of these MRI examination results were negative for injury. None of the patients experienced neurologic deterioration. No patient required operative management of spinal injury.

Conclusion: Blunt trauma patients with normal motor examination results and normal CT results of the cervical spine do not require further radiologic examination before clearing the cervical spine.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cervical Vertebrae / injuries*
  • Female
  • Fracture Fixation / methods
  • Fracture Healing / physiology
  • Glasgow Coma Scale
  • Humans
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Male
  • Middle Aged
  • Motor Skills / physiology*
  • Neurologic Examination
  • Prognosis
  • Prospective Studies
  • Reference Values
  • Registries
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Spinal Injuries / diagnosis*
  • Spinal Injuries / physiopathology
  • Tomography, X-Ray Computed
  • Unnecessary Procedures*
  • Wounds, Nonpenetrating / diagnosis*
  • Wounds, Nonpenetrating / physiopathology