MRI in Cervical Fractures - Wheeless' Textbook of Orthopaedics

- See:
- MRI Spine: Discussion;
- Role of CT in C-spine Injuries:

- Discussion:
- for visualizing soft tissue and neural elements, & unsuspected disc herniations in presence of cercial spine fractures;
- disc herniation may indicate disruption of anterior or posterior longitudinal ligament;
- MRI is useful when traumatic disk herniation may accompany an injury;
- differentiates cord edema from hemorrhage or vascular infarction;
- is useful for delineating SCIWORA syndrome;
- for visualizing widening of the interspinous, interlaminar, or facet distances, prevertebral soft tissue prominence
- in pts w/ neurologic deficit - differentiate a compressive, extradural lesion from an intramedullary lesion injury;
- epidural hematoma:
- has a characteristic signal intensity, depending on age of the injury;
- is not centered at the disc space;
- preop knowledge of such space occupying compressive lesions is essential in pts who are considered for surgery;
- intramedullary lesion, such as cord contussion, can be differentiated from hematoma on basis of signal characteristics obtained on both T1 and T2 weighted images;
- intramedullary hematoma has mixed signal on short TR (T1) images & displays central low intensity surrounded by high intensity on long TR (T2) images;
- cord edema has normal T1 intensity, & is homogenously hyperintense on long TR (T2) images;

- Contraindications:
- pts w/ pacemaker, aneurysm clips, metallic fragments in eye or spinal cord, or severe claustrophobia;

Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation.

MRI evaluation of the cervical spine in the comatose or obtunded trauma patient. D’Alise MD. J Neurosurg. 1999; 91 (suppl): 54-59.

Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury: MRI for the evaluation of patients with occult cervical spine injury. Benzel EC J Neurosurg. 1996; 85: 824-829.

Acute cervical cord injury without fracture or dislocation of the spinal column. Koyanagi I. J Neurosurg. 2000; 93: 15-20.