Furthermore, flexion-extension radiographs carry the real danger of producing neurologic injury. CT Myelography Cervical Spine There is no role for myelography in assessment of an obtunded patient without traumatic injury identified on CT in the absence of physical examination signs of spinal cord or nerve root injury. CTA Head and Neck Patients presenting with a neurologic abnormality that is unexplained by a diagnosed cervical spine injury should be evaluated for blunt cerebrovascular injury [65]. While not limited to obtunded patients, recent prospective multicenter trials suggest that MRI has a role in evaluating patients who have a negative cervical spine CT. The Western Trauma Association Multi-Institutional trial reported that CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. A small but clinically significant incidence of a missed injury was noted [56]. The prospective ReCONECT trial studied 767 patients who had a negative cervical spine CT and went on to MRI because of cervicalgia (43.0%), inability to evaluate (44.1%), or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft-tissue swelling (4.3%), vertebral disc injury (1.4%), and dural hematomas (1.3%). The patients with abnormal MRI were less likely to have their cervical collar removed than those with normal MRI (13.3% versus 88.1%). Eleven patients underwent cervical spine surgery after the MRI results. The clinical significance of these abnormal MRI findings could not be determined from this study group [55]. By inference, it is likely that some obtunded patients with negative cervical spine CT will have abnormal MRI, and some of these MRI-detected injuries may require treatment. MRA Neck There is no role for MRA in assessment of obtunded patients without traumatic injury identified on CT in the absence of clinical findings concerning for cervical vascular injury.
Suspected Spine Trauma PCAs. Furthermore, flexion-extension radiographs carry the real danger of producing neurologic injury. CT Myelography Cervical Spine There is no role for myelography in assessment of an obtunded patient without traumatic injury identified on CT in the absence of physical examination signs of spinal cord or nerve root injury. CTA Head and Neck Patients presenting with a neurologic abnormality that is unexplained by a diagnosed cervical spine injury should be evaluated for blunt cerebrovascular injury [65]. While not limited to obtunded patients, recent prospective multicenter trials suggest that MRI has a role in evaluating patients who have a negative cervical spine CT. The Western Trauma Association Multi-Institutional trial reported that CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. A small but clinically significant incidence of a missed injury was noted [56]. The prospective ReCONECT trial studied 767 patients who had a negative cervical spine CT and went on to MRI because of cervicalgia (43.0%), inability to evaluate (44.1%), or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft-tissue swelling (4.3%), vertebral disc injury (1.4%), and dural hematomas (1.3%). The patients with abnormal MRI were less likely to have their cervical collar removed than those with normal MRI (13.3% versus 88.1%). Eleven patients underwent cervical spine surgery after the MRI results. The clinical significance of these abnormal MRI findings could not be determined from this study group [55]. By inference, it is likely that some obtunded patients with negative cervical spine CT will have abnormal MRI, and some of these MRI-detected injuries may require treatment. MRA Neck There is no role for MRA in assessment of obtunded patients without traumatic injury identified on CT in the absence of clinical findings concerning for cervical vascular injury.