Title: Imaging of Spinal Cord Injuries
Authors: Kahi A, Hockberger R.
Journal: Emergency Medicine Clinics of North America (2007)
Radiographs (including flexion/extension views) are used commonly as screening but may be insufficient especially in cases of
obtunded or unresponsive patients.
CT scan has been increasingly used as an imaging modality for spine trauma and has high sensitivity and specificity, but the high
levels of radiation exposure associated with CT is concerning.
MRI is the most useful imaging modality for evaluation of the spinal cord itself as well as the other soft tissue structures of the spine.
Early diagnosis and management of spinal cord injury is critical in minimizing complications and the severity of the injury so maging
modalities must be carefully selected to allow for early detection of injury without additional risk to the patient.
Blunt mechanism trauma (e.g. motor vehicle crashes) account for 46.9% of cases followed by falls, acts of violence, and sports
injuries. ; penetrating trauma accounts for 10-20% of cases.
55% of all spine injuries involve the cervical spine with lesser but equal percentage involving the thoracic (15%), thoracolumbar
(15%), and lumbosacral (15%) regions.
Spinal cord injury without radiographic abnormality (SCIWORA) is defined as the presence of neurologic deficits in the absence of an
apparent injury on a complete, technically adequate plain radiographic series and is more commonly seen in the pediatric patient
Two clinical decision rules have been developed to help promote the judicious use of radiography in evaluating trauma patients.
Flexion-extension (F/E) radiographic series can be useful in detecting ligamentous injury in the setting of negative x-rays or an
obtunded patient but have high false positive and false negative rates.
CT and MRI
CT and MRI are playing increasingly important roles in the evaluation of thoracic and lumbar injury but concern remains about the
high cost of these imaging modalities.
MRI is widely accepted as the imaging modality of choice for identify the spinal cord and other soft tissue structures of the spine as
well as to diagnose SCIWORA in which MRI findings include central disc herniation, spinal stenosis, cord edema, and contusion.
The disadvantages of CT include higher doses of radiation, decreased efficacy in the presence of severe degenerative disease, and
limited ability to evaluate soft tissue structures.
MRI has some additional complications as it may be associated with delays, risk with transport, and equipment (ventilators,
monitors) must be compatible with the MRI machine.
Helical CT has also been shown to have superior accuracy (Figures 2A-D) and is not associated with the high levels of radiation that is
involved when evaluating the cervical spine
Pediatric Spinal Injuries
Pediatric injuries comprise only 2-5% of all spine injuries with most being from motor vehicle accidents. ,
Spine injuries are more common in children over the age of 8 years but SCIWORA accounts for 2/3 of severe c-spine injuries in those
Geriatric Spinal Injuries
The elderly account for a disproportionate majority of total spine injuries with age over 65 years being shown to have increased
Older age is also associated with greater morbidity and decreased self-reported favorable outcomes after spine injury.
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