Cervical Spine Magnetic Resonance Imaging

• Posttraumatic Neurogenic Thoracic Outlet Syndrome and Immediate Effects of Decompressive Surgery: A Case Report
• Epitheloid Osteoblastoma of C2 Vertebra as an Unusual Cause of Developmental Torticollis: A Case Report
• Basilar Invagination Diagnosis, Classification, and Radiology: WFNS Spine Committee Recommendations
• Radiological evaluation and clinical implications of deep learning- and MRI-based synthetic CT for the assessment of cervical spine injuries
• Thyroid incidentalomas in cervical spine MRI
• Predictive Factors for Postoperative Outcomes of Cervical Spondylotic Myelopathy in Individuals With Cerebral Palsy
• Prospective observational study to assess the performance accuracy of clinical decision rules in children presenting to emergency departments with possible cervical spine injuries: the Study of Neck Injuries in Children (SONIC)
• Diagnosis of C5 segmental vertebral artery using magnetic resonance angiography

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 ¹⁾. It has been recommended that this MRI should be done within 48 hours ²⁾ or 72 hours ³⁾ of injury. MRI is not reliable for identifying the osseous injury.

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 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 comatose 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 ⁴⁾. 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

see Dynamic Cervical Magnetic Resonance Imaging.