If there is concern for arterial dissection that is due to the mechanism of injury, please refer to Variant 5. Arteriography Cervicocerebral There is no role for arteriography in the assessment of patients with suspected traumatic cervical spinal cord or nerve root injury. If there is concern for arterial dissection that is due to the mechanism of injury, please refer to Variant 5. Variant 4: Age greater than or equal to 16 years. Acute cervical spine injury detected on radiographs. Treatment planning for mechanically unstable spine. CT Myelography Cervical Spine There is no role for CT myelography in the preoperative assessment of a mechanically unstable cervical spine in the absence of cervical spinal cord injury. If spinal cord injury is present, CT myelography may be beneficial in identifying the level and extent of cervical cord compression to aid in planning for cervical decompression. However, CT myelography is inferior to MRI in assessing cord contusion, cord hemorrhage, and postganglionic nerve root injuries [40,41,43,57], making CT myelography less desirable than MRI for preoperative assessment for the unstable cervical spine with associated neurologic injury. CT Cervical Spine CT of the cervical spine is essential in the preoperative assessment of an unstable cervical spine injury. CT is the gold standard for identification of cervical spine fractures [31] and is complementary to MRI in preoperative assessment. Contrast does not provide added value. MRI Cervical Spine MRI is complementary to CT in preoperative assessment of the unstable cervical spine. Assessment of the discoligamentous complex integrity is a crucial component in preoperative assessment of the cervical spine [60,61]. Discoligamentous injury is invariably present in a mechanically unstable cervical spine, and MRI is the gold standard for assessment of soft-tissue injuries, including injury to the discoligament complex [37-42].
Suspected Spine Trauma PCAs. If there is concern for arterial dissection that is due to the mechanism of injury, please refer to Variant 5. Arteriography Cervicocerebral There is no role for arteriography in the assessment of patients with suspected traumatic cervical spinal cord or nerve root injury. If there is concern for arterial dissection that is due to the mechanism of injury, please refer to Variant 5. Variant 4: Age greater than or equal to 16 years. Acute cervical spine injury detected on radiographs. Treatment planning for mechanically unstable spine. CT Myelography Cervical Spine There is no role for CT myelography in the preoperative assessment of a mechanically unstable cervical spine in the absence of cervical spinal cord injury. If spinal cord injury is present, CT myelography may be beneficial in identifying the level and extent of cervical cord compression to aid in planning for cervical decompression. However, CT myelography is inferior to MRI in assessing cord contusion, cord hemorrhage, and postganglionic nerve root injuries [40,41,43,57], making CT myelography less desirable than MRI for preoperative assessment for the unstable cervical spine with associated neurologic injury. CT Cervical Spine CT of the cervical spine is essential in the preoperative assessment of an unstable cervical spine injury. CT is the gold standard for identification of cervical spine fractures [31] and is complementary to MRI in preoperative assessment. Contrast does not provide added value. MRI Cervical Spine MRI is complementary to CT in preoperative assessment of the unstable cervical spine. Assessment of the discoligamentous complex integrity is a crucial component in preoperative assessment of the cervical spine [60,61]. Discoligamentous injury is invariably present in a mechanically unstable cervical spine, and MRI is the gold standard for assessment of soft-tissue injuries, including injury to the discoligament complex [37-42].