Cervical Spine Injuries in Older Patients with Falls Found on Magnetic Resonance Imaging After Computed Tomography

Introduction: In this study we aimed to determine the rate of traumatic abnormalities on cervical spine magnetic resonance imaging (MRI) after a normal cervical spine computed tomography (CT) in older patients with ground-level falls. We hypothesized that MRI is low yield following a normal physical examination and normal CT after a ground-level fall. Methods: This was a retrospective cohort study of patients 65 years and older evaluated with a cervical spine MRI following a ground-level fall. Inclusion criteria included age 65 years and older, ground-level fall, normal cervical spine CT followed by a cervical spine MRI. We abstracted data following accepted methodologic guidelines. Patients with any focal neurological finding were considered to have an abnormal neurological examination. Imaging studies were considered to be abnormal if there was a report of an acute traumatic injury. The primary outcome was a traumatic abnormality identified on MRI. We described data with simple descriptive statistics. Results: Eighty-seven patients with a median age of 74 (interquartile range [IQR] 69, 83]) years had an MRI following a normal cervical spine CT. Median emergency department length of stay was 8.2 hours (IQR 5.3, 13.5). Sixty-four (73.6%) patients had a normal neurological examination on arrival; eight of these patients (12.5% (95% confidence interval [CI], 5.6-23.2%) had an abnormal cervical spine MRI. Twenty-three patients (26.4%) had an abnormal neurological examination on arrival; two of these patients (8.7%, 95% CI, 1.1-28%) had an abnormal cervical spine MRI. Overall, 10 patients (11.5%) had an abnormal cervical spine MRI. One patient underwent operative intervention due to an unstable injury. Of the remaining nine patients with acute findings on cervical spine MRI, there were no other unstable injuries; two patients were managed with cervical orthosis, and seven patients had no additional management. Conclusion: In this study of older patients with ground-level falls and normal, atraumatic, cervical spine CT, a small portion had traumatic abnormalities on MRI, with few requiring further intervention. Further study is required to identify criteria to determine when MRI should be performed in older patients after a ground-level fall.

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Computed Tomography Alone Versus Computed Tomography and Magnetic Resonance Imaging in the Identification of Occult Injuries to the Cervical Spine: A Meta-Analysis

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3181c0b67a ◽

2010 ◽

Vol 68 (1) ◽

pp. 109-114 ◽

Cited By ~ 58

Author(s):

Andrew J. Schoenfeld ◽

Christopher M. Bono ◽

Kevin J. McGuire ◽

Natalie Warholic ◽

Mitchel B. Harris

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Meta Analysis ◽

Resonance Imaging

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Modification of the ventral approach to the caudal cervical spine by resection of the manubrium in a dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-09-02-0015 ◽

2009 ◽

Vol 22 (06) ◽

pp. 514-516 ◽

Cited By ~ 2

Author(s):

M. R. Owen ◽

M. A. Bush

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Cervical Spine ◽

Magnetic Resonance ◽

Neurological Examination ◽

Resonance Imaging ◽

Successful Performance ◽

Disc Material ◽

History Of ◽

Adverse Affects

SummaryA five-year-old neutered female Bassett Hound weighing 29 kg was presented with a two-day history of paraparesis. Neurological examination and magnetic resonance imaging confirmed the presence of extruded disc material ventral to the spinal cord, from the C7-T1 intervertebral disc. A ventral slot was performed to decompress the cord. In making the approach to the caudal cervical spine, the cranial aspect of the manubrium of the sternum was resected. This improved the exposure of a region normally difficult to expose via a conventional ventral approach to the cervical spine. The successful performance of the ventral slot procedure was greatly facilitated by this adaptation, which was quick and simple to perform, without any apparent adverse affects to the animal.

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The Utility of Adding Magnetic Resonance Imaging to Computed Tomography Alone in the Evaluation of Cervical Spine Injury: A Propensity Matched Analysis

The Spine Journal ◽

10.1016/j.spinee.2017.07.118 ◽

2017 ◽

Vol 17 (10) ◽

pp. S129-S130

Author(s):

Andrew J. Schoenfeld ◽

James D. Kang ◽

Christopher M. Bono ◽

Mitchel Harris

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Cervical Spine Injury ◽

Spine Injury ◽

Resonance Imaging

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Trauma Imaging

DeckerMed Surgery ◽

10.2310/surg.2185 ◽

2020 ◽

Author(s):

Joel A. Gross ◽

Martin L. Gunn ◽

Kathleen R. Fink

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Penetrating Trauma ◽

Organ Injury ◽

Bladder Rupture ◽

Subdural Hemorrhage ◽

Solid Organ ◽

Resonance Imaging

Due to increased use of computed tomography (CT) and ultrasonography, technological advances in equipment design, and increased availability of imaging equipment in the emergency department, imaging studies have revolutionized the assessment of the trauma patient in the past three decades. This review examines commonly used imaging modalities in trauma evaluation, initial and additional imaging, brief introduction to CT, and an overview of CT image processing and reviewing a CT scan. Head imaging, spine imaging, chest imaging, and abdominal and pelvic imaging are presented, along with injury grading, solid-organ injury appearances and specific abdominal solid-organ injuries, urinary system injury, penetrating trauma, unexplained intraperitoneal fluid, vascular injury and musculoskeletal injury. Figures show lateral view of the cervical spine; volume rendering of the pelvis; CT windows; CT imaging of acute intracranial bleeding, herniation in acute subdural hemorrhage, post-traumatic pseudoaneurysm of descending thoracic aorta, subscapular hematoma of the liver, liver laceration, pseudoaneurysm of the liver, shattered kidney and the nonperfused right kidney attributable to a traumatic renal artery injury, tigroid spleen, a focus of gas and stranding adjacent to the lateral wall of the ascending colon, extravasated urinary contrast (white material) surrounding the proximal right indicating ureteral laceration or transection, intraperitoneal bladder rupture, and contrast extravasation in the liver; magnetic resonance imaging versus CT of shear injuries; and magnetic resonance imaging in the setting of cervical spine trauma. This review contains 18 highly rendered figures, 23 tables, and 83 references. Keywords:Trauma, computed tomography, radiography, magnetic resonance imaging, ultrasonography, imaging study

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Charcot Arthropathy of the Wrist Associated with Cervical Spondylotic Myelopathy

Global Spine Journal ◽

10.1055/s-0032-1315457 ◽

2012 ◽

Vol 2 (4) ◽

pp. 227-230

Author(s):

Keith Jackson ◽

Uma Ramadorai ◽

Brian Abell ◽

John DeVine

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Spine ◽

Magnetic Resonance ◽

Upper Extremity ◽

Neurological Examination ◽

Appendicular Skeleton ◽

Charcot Arthropathy ◽

Resonance Imaging ◽

Tabes Dorsalis ◽

Radiocarpal Joint

Background Charcot arthropathy is a cascade of destructive changes that can effect joints of both the axial and appendicular skeleton. The pathogenesis of this condition centers around the accumulation of minor traumatic events after the loss of normal joint sensation. The most frequently cited cause of Charcot arthropathy of the upper extremity is syringomyelia, and magnetic resonance imaging of the cervical spine should be obtained at presentation. Case Report A 72-year-old woman presented with a painless right wrist deformity. Radiographs demonstrated advanced destructive changes of the radiocarpal joint. Magnetic resonance imaging of the cervical spine revealed multilevel cervical spondylotic stenosis with cord deformation, but no evidence of syringomyelia. Neurological examination confirmed the presence of myelopathy. Literature Review The most frequently cited cause of Charcot arthropathy of the upper extremity is syringomyelia, although pathologies such as diabetes mellitus, tabes dorsalis, leprosy, and other disorders affecting the nervous system have been reported to lead to this condition. Neuropathic arthropathy involving the wrist is a rare phenomenon with fewer than 20 published reports in modern literature. Clinical Relevance Charcot arthropathy of the wrist is a rare but potentially disabling condition. The diagnosis of spondylotic myelopathy should be considered when evaluating a patient with this presentation. Evaluation consisting of a detailed neurological examination and advanced imaging of the cervical spine is warranted to identify the etiology.

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Comparison of Magnetic Resonance Imaging and Computed Tomography in Predicting Facet Arthrosis in the Cervical Spine

Spine ◽

10.1097/brs.0b013e3181919526 ◽

2009 ◽

Vol 34 (1) ◽

pp. 65-68 ◽

Cited By ~ 13

Author(s):

Ronald A. Lehman ◽

Melvin D. Helgeson ◽

Kathryn A. Keeler ◽

Torphong Bunmaprasert ◽

K Daniel Riew

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Resonance Imaging

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Ulus Travma Acil Cerrahi Derg. Baskıdaki Makaleler: UTD-35813 | DOI: 10.14744/tjtes.2019.35813 Anstabil servikal yaralanmalarda Bilgisayarlı Tomografi ve Magnetik Rezonans Görüntüleme Bulgularının Karşılaştırılması Meltem Songur Kodik1, Cenk Eraslan2, Omer Kitis2, Yusuf Ali Altunci1, Huseyin Biceroglu3, Ali Akay4 1Ege Üniversitesi Tıp Fakültesi Hastanesi, Acil Tıp Anabilim Dalı, İzmir 2Ege Üniversitesi Tıp Fakültesi Hastanesi, Radyoloji Anabilim Dalı, İzmir 3Ege Üniversitesi Tıp Fakültesi Hastanesi, Beyin Cerrahisi Anabilim Dalı, İzmir 4Kent Hastanesi, Beyin Cerrahisi Bölümü, İzmir Amaç: Bu çalışmanın amacı atlanabilen anstabil servikal yaralanmaların belirlenmesinde bilgisayarlı tomografinin (BT) rolünü araştırmaktır. Yöntem: Bu çalışmada acil servise Haziran 2014 ile Haziran 2018 arasında künt servikal travma tanısı ile başvuran olgular yer almaktadır. Tüm olgular ilk önce yapılan bir BT tetkikini takiben servikal manyetik rezonans (MR) görüntülemesine tabi tutulmuşlardır. Tüm görüntüleme sonuçları gözden geçirilmiş ve kararlar acil tıp uzmanı, nöroradyolojist ve beyin cerrahından oluşan bir ekip tarafından fikir birliği ile alınmıştır. Diğer değişkenler arasında yaş, cinsiyet, Glasgow koma skalası, ek morbidite, çoklu travma, nörolojik defisitler, intrakraniyal hemoraji, ekstremite fraktürleri ve yaralanmanın mekanizması yer almaktadır. Bulgular: Çalışmaya alınan 195 hastanın bilgileri analiz edildiğinde; hastaların ortalama yaşı (±standart sapma) 47,34 ± 21,90 yıl olup 140’ ı erkek (%71,8) 18’ i (% 9,2) 18 yaşın altında idi. En sık görülen yaralanma mekanizması yüksekten düşme idi ( n=100; %51,3). Altın standart olarak MR kullanılmış olup, anstabil servikal travma tanısında BT’ nin duyarlılığı %77,7 (% 95 GA [67,1-86,1]) iken, özgüllüğü % 100,0 (%95 GA [59,0-100,0]) saptanmıştır. Sonuç: Her ne kadar bilgisayarlı tomografi anstabil servikal yaralanmaların tanısında rölatif olarak iyi olsa da duyarlılığı yeterli değildir. Bundan dolayı anstabil yaralanması olan olgularda MR çekilmesi daha uygundur. Anahtar Kelimeler: Servikal Vertebra, Boyun Yaralanmaları, Magnetik Rezonans Görüntüleme, Bilgisayarlı Tomografi, Sensivite ve Spesifite Computed Tomography vs. Magnetic Resonance Imaging in Unstable Cervical Spine Injuries

Turkish Journal of Trauma and Emergency Surgery ◽

10.14744/tjtes.2019.35813 ◽

2019 ◽

Author(s):

Meltem Songur Kodik

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Unstable Cervical Spine

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The Current Role of Magnetic Resonance Imaging for Diagnosing Cervical Spine Injury in Blunt Trauma Patients with Negative Computed Tomography Scan

The American Surgeon ◽

10.1177/000313481207801032 ◽

2012 ◽

Vol 78 (10) ◽

pp. 1156-1160 ◽

Cited By ~ 12

Author(s):

Meghann L. Kaiser ◽

Matthew D. Whealon ◽

Cristobal Barrios ◽

Allen P. Kong ◽

Michael E. Lekawa ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cervical Spine ◽

Magnetic Resonance ◽

Blunt Trauma ◽

Multidetector Ct ◽

Spine Injury ◽

Trauma Patients ◽

Resonance Imaging ◽

Mri Findings

Clearance of cervical spine (CS) precautions in the neurologically altered blunt trauma patient can be difficult. Physical examination is not reliable, and although computed tomography (CT) may reveal no evidence of fracture, it is generally believed to be an inferior modality for assessing ligamentous and cord injuries. However, magnetic resonance imaging (MRI) is expensive and may be risky in critically ill patients. Conversely, prolonged rigid collar use is associated with pressure ulceration and other complications. Multidetector CT raises the possibility of clearing CS on the basis of CT alone. We performed a retrospective review at our Level I trauma center of all blunt trauma patients with Glasgow Coma Scale Score 14 or less who underwent both CT and MRI CS with negative CT. One hundred fourteen patients met inclusion criteria, of which 23 had MRI findings. Seven (6%) of these had neurologic deficits and/or a change in management on the basis of MRI findings. Although use of the single-slice scanner was significantly associated with MRI findings (odds ratio, 2.62; P = 0.023), no significant clinical risk factors were identified. Patients with MRI findings were heterogeneous in terms of age, mechanism, and Injury Severity Score. We conclude that CS MRI continues play a vital role in the workup of neurologically altered patients.

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