+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient



Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient



Journal of Neurosurgery 91(1 Suppl.): 54-59



Object. Confirmation of cervical spine stability is difficult to obtain in the comatose or obtunded trauma patient. Concurrent therapies such as endotracheal intubation and the application of rigid cervical collars diminish the utility of plain radiographs. Bony as well as supportive soft-tissue structures must be evaluated before the cervical spine can be determined to be uninjured. Although major injuries to extradural soft-tissue structures in the awake trauma patient are frequently excluded by physical examination, when the patient is obtunded the physical examination may be unreliable. Therefore, an enhanced diagnostic method for the evaluation of soft-tissue injury is desirable. The authors conducted a study in which magnetic resonance (MR) imaging was used as such a method to assess posttraumatic spinal stability in the comatose or obtunded patient. Methods. Early, limited (sagittal T1- and T2-weighted) MR imaging was performed posttruama in 121 patients to assess soft-tissueinjury. In all patients the mechanism of injury potentially could be associated with cervical spine instability, and each patient was endotracheally intubated because of head injury or severe multisystem injuries. All patients underwent imaging studies within 48 hours of injury and were either treated or cleared and spinal precautions were discontinued. Patients were excluded from this study if they had an obvious cervical spine injury identified on the initial radiographic studies or if they were determined to be too medically unstable to undergo MR imaging within the acute period (<48 hours postinjury). Thirty-one (25.6%) of the 121 patients were found to have sustained significant injury to the paravertebral ligamentous structures, the disc interspace, or the bony cervical spine. These injuries were undetected by plain radiography. The other 90 patients (74.4%) were determined within 48 hours not to have sustained a soft-tissue injury. Eight patients (6.6%) ultimately underwent surgery to treat the cervical spine injury, and MR imaging was the first test that identified the injury in each of these patients. There were no complications related to imaging procedures. Conclusions. Sagittal T1- and T2-weighted MR imaging appears to be a safe, reliable method for evaluating the cervical spine for nonapparent injury in comatose or obtunded trauma patients. In the early postinjury period, nursing and medical care are thereby facilitated for patients in whom occult injury to the spine is ruled out and for whom those attendant precautions are unnecessary.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 010949190

Download citation: RISBibTeXText

PMID: 10419369

DOI: 10.3171/spi.1999.91.1.0054


Related references

Magnetic Resonance Imaging Evaluation of the Cervical Spine in the Comatose or Obtunded Trauma Patient. Annals of Emergency Medicine 36(1): 84-85, 2000

The value of cervical magnetic resonance imaging in the evaluation of the obtunded or comatose patient with cervical trauma, no other abnormal neurological findings, and a normal cervical computed tomography. Journal of Trauma and Acute Care Surgery 72(3): 699-702, 2012

Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. Journal of Trauma 60(1): 171-177, 2006

The utility of magnetic resonance imaging in addition to computed tomography scans in the evaluation of cervical spine injuries: a study of obtunded blunt trauma patients. European Spine Journal 27(5): 1028-1033, 2018

Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma?. Journal of Trauma 63(3): 544-549, 2007

Cervical Spine Evaluation in Obtunded or Comatose Pediatric Trauma Patients: A Pilot Study. Pediatric Neurosurgery 30(4): 169-175, 1999

Cervical spine evaluation in obtunded or comatose pediatric trauma patients: A pilot study. Pediatric Neurosurgery 30(4): 169-175, 1999

Sticking our neck out: is magnetic resonance imaging needed to clear an obtunded patient's cervical spine?. Journal of Surgical Research 187(1): 225-229, 2014

Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients?. American Journal of Surgery 206(6): 987, 2013

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. Critical Care 12(4): R89, 2008

MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: the four-year experience of a level I trauma center. Journal of Trauma 64(5): 1258-1263, 2008

Cost-effectiveness of Magnetic Resonance Imaging in Cervical Clearance of Obtunded Blunt Trauma After a Normal Computed Tomographic Finding. JAMA Surgery 153(7): 625-632, 2018

The role of MRI in the clearance of the cervical spine in the obtunded blunt trauma patient. Journal of Trauma 68(5): 1269-1270, 2010

Cervical spine magnetic resonance imaging in blunt cervical trauma patients. Journal of Trauma and Acute Care Surgery 83(4): 748-749, 2017

Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery 78(2): 430-441, 2015