Devoted to diagnostic and interventional spine imaging and therapeutics


Grading of Nuchal Ligament Injuries in Cervical Trauma Patients with Flexion Injuries 2012

General Spine

Kamron, Izadi, M.D.
John, L., Go, M.D., Non ASSR Member
Michael, J., Kim, M.D., Non ASSR Member
Paul, E., Kim, M.D., Non ASSR Member
Meng, Law, M.D., Non ASSR Member



Abnormal edematous MRI signal has been frequently described within and around the nuchal ligament in cervical spinal injuries during trauma, but no definitive grading system has been used to classify these injuries. We have adapted a grading system to describe nuchal ligamentous injuries in a series of trauma patients at our institution who have undergone flexion injuries.

Methods & Materials

Using retrospective analysis of imaging reports, we obtained a list of 30 patients who had traumatic cervical spinal injuries at our institution with described abnormal signal either within or around the nuchal ligament. These patients presented between February of 2010 and September of 2011. These patients all had CTs of the cervical spine followed by MRIs of the cervical spine to further characterize their soft tissue and osseous injuries. Injuries ranged from abnormal soft tissue edema with muscle/ligamentous strain to stable cervical spine fractures and then unstable fractures. A Grade I nuchal ligament injury consisted of edematous signal around the nuchal ligament without abnormal intrinsic signal. A Grade II injury was intrinsic edema of the nuchal ligament with intact fibers or a "sprain." A Grade III injury was a partial thickness tear of the ligament involving either the superficial or deep fibers. A Grade IV injury was a complete tear through the ligament.


In our group of 30 patients with cervical injuries, 5 patients had Grade I nuchal ligamentous injuries, 12 suffered Grade II nuchal ligamentous injuries, 7 suffered Grade III injuries and 6 suffered Grade IV injuries.


We have created a simple grading system to classify nuchal ligamentous injuries in traumatic patients who have undergone flexion injuries. This grading system may have some value in predicting severity of spinal injury. A future study can be designed to correlate the severity of cervical spinal injuries to that of the nuchal ligament based on our grading system.

References/Financial Disclosures

Benedetti P, Fahr L, Kuhns L, Hayman L. MR Imaging findings in spinal ligamentous injury. American Journal of Roentgenology 2000;175(3): 661-665. Takeshita K, Peterson ET, Bylski-Austrow D, Crawford AH, et al. The nuchal ligament restrains cervical spine flexion. Spine (Phila Pa 1976). 2004;29(18):E388-93. No financial disclosures.