Document Type: Original Article

Authors

1 Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran

3 Hematology and oncology department, Alborz University of Medical Sciences, Karaj, Iran

4 Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Objective: This study investigates the possible magnetic resonance imaging (MRI) findings in patients with cervical trauma having a normal level of consciousness and normal CT reports. These patients have tenderness or an uncomfortable feeling in the traumatized area as well.
Methods: In this cross-sectional anterograde study, cases were selected among patients referred to the emergency department of Hafte Tir, Iran University of Medical Sciences from 2012 to 2014. Inclusion criteria to select cases were: age above 15, blunt neck trauma, GCS=15, normal CT scan reports of neck, no past medical history of cervical vertebral surgery, and no persistent neurologic lesions. In order to analyse qualitative data, chi-square test was used and for quantitative data t test was applied accordingly.
Results: Two hundred eighty patients with chief complaints of neck pain due to trauma entered our study. Among this batch, 264 of them had normal CT scan reports and MRI was done for all of them. According to the results, the maximum injury in MRI was related to intervertebral disc injury (38 cases), ligamentous edema (35 cases), and muscle edema (22 cases), respectively. Neck tenderness from the beginning of the accident and transient neurologic signs had a significant role in MRI results (P < 0.05).
Conclusion: In patients with acute cervical trauma having normal CT reports, MRI must be done in those with the average age of 45 or more, tenderness in the neck area, and in those with neurologic transient symptoms.

Keywords

Main Subjects

1. Snell RS, Smith MS. Clinical Anatomy for Emergency Medicine. 1st ed. St. Louis: Mosby; 1993.
2. Sabiston DC. Neurosurgery. In: Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Elsevier; 2016.
3. van den Berg ME, Castellote JM, Mahillo-Fernandez I, de Pedro-Cuesta J. Incidence of spinal cord injury worldwide: a systematic review. Neuroepidemiology 2010; 34(3): 184- 92. doi: 10.1159/000279335.
4. Geisler FH, Coleman WP, Grieco G, Poonian D. Recruitment and early treatment in a multicenter study of acute spinal cord injury. Spine (Phila Pa 1976) 2001; 26(24Suppl): S58-67.
5. Ojaghi Haghighi SH, Adimi I, Shams Vahdati S, Sarkhoshi Khiavi R. Ultrasonographic diagnosis of suspected hemopneumothorax in trauma patients. Trauma Mon 2014; 19(4): e17498. doi: 10.5812/traumamon.17498.
6. Tajoddini S, Shams Vahdati S. Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency
physicians and radiologists. Eur J Trauma Emerg Surg 2013;39(1): 9-13. doi: 10.1007/s00068-012-0219-5.
7. Ala A, Shams Vahdati S, Taghizadieh A, Miri SH, Kazemi N, Hodjati SR, et al. Cervical collar effect on pulmonary
volumes in patients with trauma. Eur J Trauma Emerg Surg 2016; 42(5): 657-60. doi: 10.1007/s00068-015-0565-1.
8. Saltzherr TP, Fung Kon Jin PH, Beenen LF, Vandertop WP, Goslings JC. Diagnostic imaging of cervical spine injuries following blunt trauma: a review of the literature and practical guideline. Injury 2009; 40(8): 795-800. doi:10.1016/j.injury.2009.01.015.
9. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000; 343(2): 94-9. doi: 10.1056/nejm200007133430203.

10. Dunham CM, Brocker BP, Collier BD, Gemmel DJ. Risks associated with magnetic resonance imaging and cervical
collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit. Crit Care 2008; 12(4): R89. doi:10.1186/cc6957.
11. Steigelman M, Lopez P, Dent D, Myers J, Corneille M, Stewart R, et al. Screening cervical spine MRI after normal
cervical spine CT scans in patients in whom cervical spine injury cannot be excluded by physical examination. Am J
Surg 2008; 196(6): 857-62; discussion 62-3. doi: 10.1016/j.amjsurg.2008.07.040.
12. Hogan GJ, Mirvis SE, Shanmuganathan K, Scalea TM. Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal? Radiology 2005; 237(1): 106-13. doi: 10.1148/radiol.2371040697.
13. Schuster R, Waxman K, Sanchez B, Becerra S, Chung R, Conner S, 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(8): 762-6. doi: 10.1001/archsurg.140.8.762.
14. Ackland HM, Cameron PA, Varma DK, Fitt GJ, Cooper DJ, Wolfe R, et al. Cervical spine magnetic resonance imaging in alert, neurologically intact trauma patients with persistent midline tenderness and negative computed tomography results. Ann Emerg Med 2011; 58(6): 521-30.doi: 10.1016/j.annemergmed.2011.06.008.
15. Schoenfeld AJ, Bono CM, McGuire KJ, Warholic N, Harris MB. Computed tomography alone versus computed tomography and magnetic resonance imaging in the identification of occult injuries to the cervical spine: a meta-analysis. J Trauma 2010; 68(1): 109-13; discussion 13-4. doi: 10.1097/TA.0b013e3181c0b67a.
16. Holmes JF, Mirvis SE, Panacek EA, Hoffman JR, Mower WR, Velmahos GC. Variability in computed tomography
and magnetic resonance imaging in patients with cervical spine injuries. J Trauma 2002; 53(3): 524-9. doi: 10.1097/01.
ta.0000026405.09344.11.
17. Cohen WA, Giauque AP, Hallam DK, Linnau KF, Mann FA. Evidence-based approach to use of MR imaging in acute
spinal trauma. Eur J Radiol 2003; 48(1): 49-60.
18. Plumb JO, Morris CG. Clinical review: Spinal imaging for the adult obtunded blunt trauma patient: update from
2004. Intensive Care Med 2012; 38(5): 752-71. doi: 10.1007/s00134-012-2485-4.
19. Menaker J, Philp A, Boswell S, Scalea TM. Computed tomography alone for cervical spine clearance in the unreliable patient--are we there yet? J Trauma 2008; 64(4):898-903; discussion -4. doi: 10.1097/TA.0b013e3181674675.
20. Panczykowski DM, Tomycz ND, Okonkwo DO. Comparative effectiveness of using computed tomography alone to exclude cervical spine injuries in obtunded or intubated patients: meta-analysis of 14,327 patients with blunt trauma. J Neurosurg 2011; 115(3): 541-9. doi:10.3171/2011.4.jns101672.
21. Tewari MK, Gifti DS, Singh P, Khosla VK, Mathuriya SN, Gupta SK, et al. Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients. Surg Neurol 2005; 63(3): 204-9. doi: 10.1016/j.surneu.2004.05.042.
22. Como JJ, Thompson MA, Anderson JS, Shah RR, Claridge JA, Yowler CJ, et al. Is magnetic resonance imaging essential
in clearing the cervical spine in obtunded patients with blunt trauma? J Trauma 2007; 63(3): 544-9. doi: 10.1097/TA.0b013e31812e51ae.
23. Greenbaum J, Walters N, Levy PD. An evidenced-based approach to radiographic assessment of cervical spine injuries in the emergency department. J Emerg Med 2009;36(1): 64-71. doi: 10.1016/j.jemermed.2008.01.014.