In this situation, where the level and nature of a suspected lesion are known, flexion-extension radiographs may aid in assessing the significance of the MRI findings. However, care should be taken to ensure adequate flexion and extension of cervical radiographs as muscle spasm can limit cervical mobility, masking mechanically unstable cervical injuries. CT Myelography Cervical Spine There is no role for CT myelography in assessment of suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. CTA Head and Neck There is no role for CTA in assessment of patients with suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. MRI is superior to CT in identifying cervical spine ligament injuries. However, ligament injuries that are occult on CT and identified on MRI rarely result in significant changes in clinical management. Studies looking at presence of soft-tissue injury on cervical spine MRI in patients with unreliable examination and negative CT have found MRI to be positive in 6% to 49% of patients [41,44,45,47,48,78]. Most of these injuries were minor, requiring either no change in management or only extended cervical collar placement. Less than 1% of patients with unreliable clinical examination and negative cervical spine CT will have an unstable cervical spine injury requiring surgical stabilization identified on MRI [38-41,44-48,78-80]. MRA Neck There is no role for MRA in assessment of patients with suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. Arteriography Cervicocerebral There is no role for arteriography in assessment of patients with suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. Variant 8: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Follow-up imaging on patient with no unstable injury demonstrated initially, but kept in collar for neck pain. No new neurologic symptoms.
Suspected Spine Trauma PCAs. In this situation, where the level and nature of a suspected lesion are known, flexion-extension radiographs may aid in assessing the significance of the MRI findings. However, care should be taken to ensure adequate flexion and extension of cervical radiographs as muscle spasm can limit cervical mobility, masking mechanically unstable cervical injuries. CT Myelography Cervical Spine There is no role for CT myelography in assessment of suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. CTA Head and Neck There is no role for CTA in assessment of patients with suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. MRI is superior to CT in identifying cervical spine ligament injuries. However, ligament injuries that are occult on CT and identified on MRI rarely result in significant changes in clinical management. Studies looking at presence of soft-tissue injury on cervical spine MRI in patients with unreliable examination and negative CT have found MRI to be positive in 6% to 49% of patients [41,44,45,47,48,78]. Most of these injuries were minor, requiring either no change in management or only extended cervical collar placement. Less than 1% of patients with unreliable clinical examination and negative cervical spine CT will have an unstable cervical spine injury requiring surgical stabilization identified on MRI [38-41,44-48,78-80]. MRA Neck There is no role for MRA in assessment of patients with suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. Arteriography Cervicocerebral There is no role for arteriography in assessment of patients with suspected cervical ligament injury in the absence of clinical suspicion for vascular injury. Variant 8: Age greater than or equal to 16 years. Suspected acute cervical spine blunt trauma. Follow-up imaging on patient with no unstable injury demonstrated initially, but kept in collar for neck pain. No new neurologic symptoms.