Editor’s Choice: Imaging of Spine Trauma

Trauma to the spinal column and spinal cord are potentially devastating injuries. Imaging is a major pillar in the evaluation of the trauma patient in addition to the history and physical examination. Computed tomography (CT) and magnetic resonance imaging (MRI) are the main imaging modalities for the evaluation of traumatic spinal injury, specifically, to confirm the exact injury location, to assess spine stability, and to delineate neural element compromise. We will review the fundamental role of imaging, focusing on the complimentary role of the different modalities, in the diagnosis of patients with traumatic injuries of the spine.

ROLE OF IMAGING IN THE ASSESSMENT OF THE TRAUMATIC SPINE

In the setting of acute spinal trauma, imaging delineates all osseous and soft tissue injuries and helps to guide potential surgical intervention. Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries by the Joint Section on Disorders of the Spine and Peripheral Nerve provide recommendations on the role of imaging for acute cervical spine and spinal cord injury patients.1 In alert, asymptomatic patients without neck pain or distracting injury, with a normal neurological examination and ability to perform a functional range of motion, clinical clearance remains the standard, and radiographic evaluation is not recommended. If the patient has neck tenderness and pain, the recommendation is CT.1 Radiographs are not recommended, because, even with the best possible technique, they underestimate the amount of traumatic spine injury. Despite repeated attempts at open-mouth odontoid and swimmers views and other variations of imaging, it is very often difficult to visualize the entirety of the cervical spine. Radiographs of the cervical spine detect only 60% to 80% of fractures, even when 3 views are obtained.2 Major trauma centers use multidetector CT (MDCT) as the primary imaging modality for evaluating patients with blunt cervical spine injury, particularly in symptomatic patients.3 CT has a higher sensitivity and specificity for evaluating cervical spine injury than radiographs, detecting 97% to 100% of fractures.2-4

From Imaging of Spine Trauma by Shah, Lubdha M.; Ross, Jeffrey S.