However, CT is significantly inferior to MRI in identifying many soft-tissue pathologies, such as spinal cord contusion, epidural hematoma, and nerve root avulsions, that can cause neurologic deficits and require surgical intervention [40,41,43,57]. Therefore, CT should not be considered adequate for excluding significant soft-tissue pathology in patients presenting with signs or symptoms of cervical spinal cord or nerve root injury. Suspected Spine Trauma Radiography Cervical Spine While radiographs may play a role in the initial assessment of cervical spine injury, there is no role for radiographs in further assessment of cervical neurologic injury that is due to the poor sensitivity and specificity of cervical radiographs in assessing soft-tissue injury. CT Myelography Cervical Spine CT myelography can be performed to assess for traumatic spinal canal narrowing that is due to disc herniation or epidural hematoma and to assess for preganglionic nerve root avulsions. However, as with conventional CT, CT myelography is inferior to MRI in assessing spinal cord contusion, spinal cord hemorrhage, and postganglionic nerve root injuries [40,41,43,57]. Performance of cervical CT myelogram can also be technically challenging, particularly in patients with suspected unstable cervical spine injury. CTA Head and Neck There is no role for CTA in the assessment of 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. In the subacute and chronic stages after cord trauma, MRI can help define the extent of cord injury. This is particularly important in patients who suffer late deterioration, which is sometimes caused by treatable etiologies, such as development or enlargement of intramedullary cavities. MRA Neck There is no role for MRA in the evaluation of suspected traumatic cervical myelopathy or radiculopathy [59].
Suspected Spine Trauma PCAs. However, CT is significantly inferior to MRI in identifying many soft-tissue pathologies, such as spinal cord contusion, epidural hematoma, and nerve root avulsions, that can cause neurologic deficits and require surgical intervention [40,41,43,57]. Therefore, CT should not be considered adequate for excluding significant soft-tissue pathology in patients presenting with signs or symptoms of cervical spinal cord or nerve root injury. Suspected Spine Trauma Radiography Cervical Spine While radiographs may play a role in the initial assessment of cervical spine injury, there is no role for radiographs in further assessment of cervical neurologic injury that is due to the poor sensitivity and specificity of cervical radiographs in assessing soft-tissue injury. CT Myelography Cervical Spine CT myelography can be performed to assess for traumatic spinal canal narrowing that is due to disc herniation or epidural hematoma and to assess for preganglionic nerve root avulsions. However, as with conventional CT, CT myelography is inferior to MRI in assessing spinal cord contusion, spinal cord hemorrhage, and postganglionic nerve root injuries [40,41,43,57]. Performance of cervical CT myelogram can also be technically challenging, particularly in patients with suspected unstable cervical spine injury. CTA Head and Neck There is no role for CTA in the assessment of 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. In the subacute and chronic stages after cord trauma, MRI can help define the extent of cord injury. This is particularly important in patients who suffer late deterioration, which is sometimes caused by treatable etiologies, such as development or enlargement of intramedullary cavities. MRA Neck There is no role for MRA in the evaluation of suspected traumatic cervical myelopathy or radiculopathy [59].