Abstract：
Magnetic resonance imaging (MRI) is increasingly used as an adjunct to spinal soft tissue evaluation in cervical spine (C-spine) trauma; however, the utility of this information remains controversial. In this consecutive observational study, we reviewed the utility of MRI in patients with C-spine trauma.
We identified patients in real time over a 2-year period as they presented to our level 1 trauma center for C-spine computed tomography (CT) scan followed by MRI. MRI was obtained by the trauma team prior to the spine service consultation if (1) they were unable to clear the C-spine according to protocol or (2) if the on-call radiologist reported a concern for ligamentous integrity from the CT findings.
Thirty-three patients, including 19 males (58%) and 14 females, with a mean age of 54 years, were referred to the spine service for concerns of ligamentous instability. The most common mechanisms of injury were motor vehicle accidents (n = 13) and falls (n = 11). MRI demonstrated ligamentous signal change identified by the radiologist as potentially unstable in all patients. Fifteen patients (45%) had multiple C-spine ligaments affected. The interspinous ligament was involved most frequently (28%), followed by the ligamentum flavum (21%) and supraspinous ligament (15%). All patients underwent dynamic upright C-spine X-rays that were interpreted by both the ordering surgeon and radiologist. There was no evidence of instability in any patient; concurrence between X-ray interpretation was 100%. The cervical collar was successfully removed in all cases. No patients required late surgical intervention, and there were no return visits to the emergency department of a spinal nature.
MRI signal change within the ligaments of the C-spine should be interpreted with caution in the setting of trauma. To physicians less familiar with spinal biomechanics, MRI findings may be perceived in an inadvertently alarming manner. Bony alignment and, when indicated, dynamic upright X-rays remain the gold standard for evaluating the ligamentous integrity of the C-spine.
We identified patients in real time over a 2-year period as they presented to our level 1 trauma center for C-spine computed tomography (CT) scan followed by MRI. MRI was obtained by the trauma team prior to the spine service consultation if (1) they were unable to clear the C-spine according to protocol or (2) if the on-call radiologist reported a concern for ligamentous integrity from the CT findings.
Thirty-three patients, including 19 males (58%) and 14 females, with a mean age of 54 years, were referred to the spine service for concerns of ligamentous instability. The most common mechanisms of injury were motor vehicle accidents (n = 13) and falls (n = 11). MRI demonstrated ligamentous signal change identified by the radiologist as potentially unstable in all patients. Fifteen patients (45%) had multiple C-spine ligaments affected. The interspinous ligament was involved most frequently (28%), followed by the ligamentum flavum (21%) and supraspinous ligament (15%). All patients underwent dynamic upright C-spine X-rays that were interpreted by both the ordering surgeon and radiologist. There was no evidence of instability in any patient; concurrence between X-ray interpretation was 100%. The cervical collar was successfully removed in all cases. No patients required late surgical intervention, and there were no return visits to the emergency department of a spinal nature.
MRI signal change within the ligaments of the C-spine should be interpreted with caution in the setting of trauma. To physicians less familiar with spinal biomechanics, MRI findings may be perceived in an inadvertently alarming manner. Bony alignment and, when indicated, dynamic upright X-rays remain the gold standard for evaluating the ligamentous integrity of the C-spine.
摘要：
背景：据报道，MRI在颈椎创伤中作为脊柱软组织评估的辅助手段的频率增加。然而,这些信息的实用性仍然存在争议。
目的：回顾MRI在颈椎外伤患者中的应用。
方法：连续观察性研究。我们在2年的时间内实时识别患者，他们被送到我们的1级创伤中心，接受颈椎CT检查，然后进行MRI检查。在以下情况下，创伤团队在脊柱服务咨询之前获得了MRI：（1）他们无法根据协议清除C型脊柱；（2）如果值班放射科医生报告了CT发现对韧带完整性的担忧。
结果：33例患者因韧带不稳定而被转诊至脊柱。有19名男性（58％）和14名女性，平均年龄为54岁。最常见的伤害机制是机动车事故（n=13）和跌倒（n=11）。MRI显示，放射科医生认为所有患者的韧带信号变化可能不稳定。15例患者（45％）受多个颈椎韧带影响。棘突间韧带受累频率最高（28%），其次是黄韧带(21%)，棘上韧带（15%）。所有患者均接受动态直立C-脊柱X线检查,由订购外科医生和放射科医生解释。没有任何患者不稳定的证据；X射线解释之间的一致性为100％。在所有情况下都成功摘除了颈圈。没有患者需要后期手术干预，也没有脊柱性急诊室的回访。
结论：在创伤背景下，应谨慎解释颈椎韧带内的MRI信号变化。对于不太熟悉脊柱生物力学的医生来说，MR发现可能以无意中令人震惊的方式被感知。Bony对齐和，当指示时，动态直立X射线仍然是评估颈椎韧带完整性的金标准。
目的：回顾MRI在颈椎外伤患者中的应用。
方法：连续观察性研究。我们在2年的时间内实时识别患者，他们被送到我们的1级创伤中心，接受颈椎CT检查，然后进行MRI检查。在以下情况下，创伤团队在脊柱服务咨询之前获得了MRI：（1）他们无法根据协议清除C型脊柱；（2）如果值班放射科医生报告了CT发现对韧带完整性的担忧。
结果：33例患者因韧带不稳定而被转诊至脊柱。有19名男性（58％）和14名女性，平均年龄为54岁。最常见的伤害机制是机动车事故（n=13）和跌倒（n=11）。MRI显示，放射科医生认为所有患者的韧带信号变化可能不稳定。15例患者（45％）受多个颈椎韧带影响。棘突间韧带受累频率最高（28%），其次是黄韧带(21%)，棘上韧带（15%）。所有患者均接受动态直立C-脊柱X线检查,由订购外科医生和放射科医生解释。没有任何患者不稳定的证据；X射线解释之间的一致性为100％。在所有情况下都成功摘除了颈圈。没有患者需要后期手术干预，也没有脊柱性急诊室的回访。
结论：在创伤背景下，应谨慎解释颈椎韧带内的MRI信号变化。对于不太熟悉脊柱生物力学的医生来说，MR发现可能以无意中令人震惊的方式被感知。Bony对齐和，当指示时，动态直立X射线仍然是评估颈椎韧带完整性的金标准。
