Cervical Spine Magnetic Resonance Imaging [Neurosurgery Wiki]

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====== Cervical Spine Magnetic Resonance Imaging ======

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{{ ::cervical_mri_scan.png?150}} 


===== General information =====

[[MRI]] may be used to identify potentially unstable occult ligamentous or soft tissue injury. Note:
an abnormal signal on MRI is not always associated with instability on flexion-extension X-rays
((Horn EM, Lekovic GP, Feiz-Erfan I, et al. Cervical
magnetic resonance imaging abnormalities not predictive
of cervical spine instability in traumatically
injured patients. J Neurosurg Spine. 2004; 1:39–42)).
It has been recommended that this MRI should be done within 48 hours
((Section on Disorders of the Spine and Peripheral
Nerves of the American Association of Neurological
Surgeons and the Congress of Neurological
Surgeons. Radiographic assessment of the cervical
spine in symptomatic trauma patients.
Neurosurgery. 2002; 50 Supplement:S36–S43))
or 72 hours
((Schuster R, Waxman K, Sanchez B, et al. Magnetic
resonance imaging is not needed to clear cervical
spines in blunt trauma patients with normal computed
tomographic results and no motor deficits.
Arch Surg. 2005; 140:762–766))
of injury. MRI is
not reliable for identifying the osseous injury.

{{::cervical_magnetic_resonance_imaging.jpg?300|}}

Abnormal MRI findings include: abnormal high signal on T2 weighted image in the occipitoatlantal
joints or in the posterior occipitoatlantal (O-C1) ligaments. Very sensitive
(≈ 100%) but not specific for unstable AOD.
The figure at left shows abnormal signal in the posterior O-C1 ligaments (arrow 1)
and in the ligamentum flavum and soft tissues (arrow 2).

===== Indications =====

Indications for non-emergent MRI (modified):

1. inconclusive [[cervical spine radiography]], including questionable fractures

2. significant midline paraspinal tenderness and patient unable to have flexion-extension X-rays

3. obtunded or [[coma]]tose patients

[[T2 weighted image]] and [[STIR]] are the most helpful sequences. Significant abnormal findings:

1. ventral signal abnormalities with prevertebral swelling

2. dorsal signal abnormalities. Abnormal signal limited to the interspinous is probably not as unstable
as when it extends into the [[ligamentum flavum]]
((Benzel EC, Hart BL, Ball PA, et al. Magnetic resonance
imaging for the evaluation of patients with
occult cervical spine injury. J Neurosurg. 1996; 85:
824–829)).
These patients were treated with rigid collars or Minerva jackets for 1–3 months, and one that was felt to be very unstable underwent fusion.

3. disc disruption indicated disc disruption indicated by abnormal signal intensity within the disc, increased disc height, or frank disc protrusions

===== Dynamic Cervical Magnetic Resonance Imaging =====

see [[Dynamic Cervical Magnetic Resonance Imaging]].