MDCT and MRI evaluation of cervical spine trauma

PURPOSE: Cervical spine injuries following major trauma result in significant associated morbidity and mortality. Devastating neurological injury, including complete and incomplete tetraplegia, are common sequelae of cervical spine trauma and cause profound and life-altering medical, financial, and social consequences. Most cervical spine injuries follow motor vehicle accidents, falls, and violence. The proliferation of multidetector computed tomography allows for fast and accurate screening for potential bony and vascular injuries. Magnetic resonance imaging is useful for evaluation of the supporting ligaments and the spinal cord after the patient has been stabilised. CONCLUSION: Cervical spine injuries are approached with much caution by emergency room clinicians. Thus, it is essential that radiologists be able to differentiate between a stable and unstable injury on MDCT, as this information ultimately helps determine the management of such injuries. TEACHING POINTS: MDCT and MRI are complementary and both may be needed to define injuries and determine management. MDCT rapidly evaluates the bones, and MRI is superior for detecting ligament and cord injuries. Injury to one of the three spinal columns may be stable, and injuries to more than one are unstable. Instability may cause abnormal interspinous and interpedicular distances, or cervical malalignment. Fractures of the foramen transversarium are associated with vertebral arterial dissection.