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Utility of MR Imaging in the Management of Traumatic Cervical Spine Fractures 2014

Category General Spine Pranav Chitkara, MD Raja Anne Srinivas Kolla, MD Scott Lehto Steven Pulitzer, M.D. Purpose 1. Review the classic imaging findings of traumatic cervical spine injuries 2. Demonstrate the salient MR imaging findings for these fracture types that are important to specialists in determining management. 3. Explain which cervical injuries and clinical scenarios require further evaluation with magnetic resonance imaging. Materials & Methods A pictorial review and demonstration of salient imaging findings on CT and MRI of the most common traumatic cervical spine injuries. Results 1. Classic CT and/or plain radiography imaging findings of common traumatic cervical spine injuries: a. Flexion injuries (Perched/jumped facet, Wedge, and Flexion teardrop fractures) b. Axial compression injuries (Jefferson) c. Extension injuries (Hangman, Hyperextension teardrop, Hyperextension, Odontoid (type II) fractures) 2. Outline which cervical spine injuries require further evaluation with MR a. Demonstrate critical MR imaging findings relative to normal MR anatomy. 3. Introduce special clnical situations that may result in normal CT imaging findings in the emergency setting but pathologic MR findings a. Neurological deficit and persistent pain in the setting of normal CT imaging Conclusion 1. Learn the significance of magnetic resonance imaging in clinical management to identify signs of osseous, ligamentous and neurological pathology. 2. Become familiar with critical injuries on MR in comparison with normal MR anatomy. 3. Develop a systematic approach to evaluate when further MR imaging is necessary in the acute/subacute setting. References - Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.  Spine 1983 Nov-Dec;8(8):817-31. - Bernstein MP, Baxter AB. Cervical spine trauma: pearls and pitfalls. Pitfalls in Clinical Imaging 2012; ARRS categorical course: 21-25. - Harris JH Jr. The cerivcocranium: its radiographic assessment. Radiology 2001 Feb; 218(2):337-351. - Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF, Northrup BE. Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology 1990; 177:25-33. - Rao SK, Wasyliw C, Nunez DB Jr. Spectrum of imaging findings in hyperextension injuries of the neck. Radiographics 2005; 25:1239-1254. - Miyanji F, Furlan JC, Aarabi B, Arnold PM, Fehlings MG. Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome—prospective study with 100 consecutive patients. Radiology 2007 June; 243(3):820-827. - Benedetti PF, Fahr LM, Kuhns LR, Hayman LA. MR imaging findings in spinal ligamentous injury. AJR 2000;175:661–665. - Hollingshead MC, Castillo M. MRI in acute spinal trauma. Applied Radiology 2007 Aug; 34-41. - Sharma S, Singha M, Wania IH, Sharma S, Sharma N, Singh D. Adult spinal cord injury without radiographic abnormalities (SCIWORA): clinical and radiological correlations. J Clin Med Res 2009;1(3):165-172. Submission ID#35946