Spinal Trauma - An Imaging Approach

In the case of persistent discomfort from one week onwards after an injury there may be a role for elective flexion extension radiographs. T2weighted MRI of the whole spine demonstrates multilevel fractures, in the upper and mid thoracic spine and in the upper lumbar spine figure a. Sagittal STIR images of the cervical spine show focal cord signal change at the C4 level, pre-existing OA, typical central cord injury in an elderly patient with pre-existing OA and no evidence of instability image b. Flexion image c and extension image d CT images show no evidence of instability.

CT can not directly visualise neural injury.

Multilevel injuries of the spine are common. MR imaging has a number of advantages over CT.

• Путешествие Алисы (Russian Edition).
• ?
• Radiology | Spinal Trauma - An Imaging Approach?
• ;
• Scrittura come nuovo inizio - Riflessioni sul romanzo diniziazione al femminile nel Cono Sur (Soglie Americane Vol. 1) (Italian Edition).
• Past Loving (Mills & Boon Modern).
• .

It does not use ionising radiation and it is sensitive for soft tissue injury and various causes of neural injury and compromise, much more so than CT Fig. MRI can assess the ligamentous structures of the spine important for stability, CT struggles with this. However MRI is not safe in a number of patients due to electronic implants or for example previous surgery with aneurysm clips.

Only fully alert and oriented patients would be able to be reliably assessed for suitability for MR imaging. MRI is also much more time consuming than CT and relies on a fully cooperative patient. MRI in ventilated patients is much more difficult and not all departments are set up for this. MRI also misses a significant number of bone injuries compared with CT. However, in cases of proven neurological injury or impairment, MR imaging is the imaging modality of choice for further assessment. MRI is also an important part in the imaging workup of children with spinal injury and is given preference over CT by some guidelines.

There has been a long discussion in the literature whether CT alone is able to rule out unstable injury of the spine. This is also reflected in the published literature. MRI should be performed as long as safe to do so in all cases of clinical neural compromise after spinal trauma. MRI can define the level and nature of injury. Importantly it may also show causes of treatable neurological compromise ie cord compression due to disc herniation or haematoma.

MRI may show root injuries and define the type, ie pre- or postganglionic. MRI may also show ligament injury leading to instability not seen on CT. In children MRI is even more important as often injuries affect the soft tissue only, rather than bone. In the past cervical spine clearance protocols based on radiographs combined with MRI have also been investigated and found to be sensitive for all relevant injuries. Vascular compromise can have devastating neurological consequences.

Available on

Obviously spinal cord or brain infarction through vascular compromise is at best difficult and more commonly impossible to mitigate but incomplete vascular compromise ie arterial dissection may be treatable and therefore has to be diagnosed. Vascular compromise is more reliably seen on contrast medium enhanced CT rather than on plain MRI, though alteration to the normal flow pattern may well be visible on MRI. Bone injury next to vascular structures ie fracture of the foramen transversarium or significant instability should alert to the risk of vascular compromise and dedicated imaging should be considered.

CT angiography will usually be the investigation of choice in these circumstances. However, MRI or MR angiography, direct arterial angiography and possibly ultrasound are imaging alternatives. Flexion extension CT Fig. However one can argue that the same problems encountered with flexion extension radiographs in the acute phase are then present. In the alert patient pain and muscle spasm may mask instability.

In the obtunded patient passive positioning in flexion and extension is potentially dangerous and may actually induce neural compromise either by instability which would only be visualised once the CT scan is performed or by soft tissue compromise of neural structures i. The ability of MRI to predict neurological outcome after spinal cord injury has been recognised many years ago. As yet they have not been shown to help in clinical management of the patient. Tractography image b, posterior projection confirms the injury. However diffusion weighted imaging does not add any significant new information.

Nerve root injuries particularly in the cervical spine can be assessed with dedicated MRI sequences giving a high spatial resolution and depicting whether root injury is pre- or postganglionic Fig. The rootlets themselves are usually directly visualised.

Meningoceles may be seen, usually markers of a preganglionic injury. Signal change in the spinal cord at the junction of the cord with the root must be considered abnormal. This may be more easily appreciated with contrast medium enhancement, focal contrast enhancement of roots or in the cord are abnormal. Axial T2 space and coronal space STIR images show absent right sided rootlets figure a and menigocele formation figure b.

MRI is able to directly visualise rootlet injuries of the spine. Conventional MRI can demonstrate muscle signal change, either oedema or fatty atrophy, with time but not as rapidly and clearly as contrast enhanced MRI.

Buy Spinal Trauma - An Imaging Approach - Microsoft Store

The multifidus muscle is here particularly useful as it is segmentally innervated by a single nerve root only. MR myelography may be used for an overview in brachial plexus injury but the spatial resolution is inferior to conventional MR sequences. One remaining question is whether CT imaging is always sufficient to clear the spine in obtunded patients or whether MRI should be considered also.

Another controversy is whether in trauma of the thoracolumbar spine radiographic clearance is acceptable or whether CT should be obtained. Finally, it is not universally agreed how trauma spine imaging in children should be performed, whether and if so which role CT plays, or whether radiographs supplemented by MRI are the imaging investigations of choice. The issues outlined above result in some variation in currently published spine trauma clearance guidelines.

• Giving up the Dead.
• ?
• ;
• Zuric. En un cap de setmana (Catalan Edition).
• .

Radiation protection and quick and safe clinical management must be the concern of all medical personnel involved but not to the detriment of missing relevant spinal injury. This remains and will remain the challenge in diagnosing, treating and caring for patients with possible or definite spinal injury.

National Center for Biotechnology Information , U. J Clin Orthop Trauma. Published online Jun Author information Article notes Copyright and License information Disclaimer. Received May 11; Accepted Jun 3. Abstract Traumatic spine injuries can be devastating for patients affected and for health care professionals if preventable neurological deterioration occurs.

Aim of imaging The main aim of imaging is to avoid preventable neurological deterioration and to aid short and long term management of spinal injury. Open in a separate window. When to image Any imaging performed will carry a cost. Advantages are availability and familiarity of attending medical personnel. Advanced imaging options Vascular compromise can have devastating neurological consequences.

Imaging protocols Few controversies remain in the imaging of spine trauma. The basic principle is the same though. It is now accepted that in skeletally mature patients the miss rate of a quality CT scan is sufficiently low to declare the spine cleared if a CT of the spine is considered normal. This holds true for the fully alert and the obtunded patient. If patients have symptoms of vascular compromise dedicated imaging is indicated, usually with CT angiography. It may be prudent to also do this in patients with significant injuries adjacent to relevant vessels.

In children radiographic assessment followed by MRI if suspicious on imaging or clinically may be a better approach than CT imaging. However, regional and local preferences may dictate the imaging approach in these cases.

Trauma to the thoracolumbar spine can be cleared with CT. If trauma CT of chest abdomen pelvis is not undertaken, dedicated CT of the spine or radiographs may be considered as first line investigations. Again regional and local preferences may prevail here.

• Missing Company? (Corporate Intent Book 3);
• Performativität und Medialität Populärer Kulturen: Theorien, Ästhetiken, Praktiken: Volume 2 (German Edition).
• .
• Capabilities.
• 1. Aim of imaging.
• Knight of Prye (Knight of Pyre Series).
• Le développement durable dans lesapce Méditerranéen: une gouvernance à inventer : Enjeux et propositions (French Edition).

Conflict of interest The author has none to declare. Delayed diagnosis of cervical spine injuries. The etiology of missed cervical spine injuries. Missed and mismanaged injuries of the spinal cord. Etiology and clinical course of missed spine fractures. Delayed diagnosis of inferior cervical spine injury. Assessment of MRI as a modality for evaluation of soft tissue injuries of the spine as compared to intraoperative assessment.

J Clin Diagn Res.

Spinal Trauma - An Imaging Approach

False-negative plain cervical spine x-rays in blunt trauma. Signs and Significance 6 Vertebral Injuries: Trends and Developments in Spinal Cord Regeneration. Lavishly illustrated with hundreds of superb MR images and CT scans The diagnosis of trauma to the spine -- where the slightest oversight may have catastrophic results -- requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. Acute trauma topics include: Optimization of imaging modalities Malalignment -- signs and significance Vertebral fractures -- detection and implications Classification of thoraco-lumbar fractures -- rationale and relevance Neurovascular injury Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: The pediatric spine Sports injuries The rigid spine Trauma in the elderly Vertebral collapse, benign and malignant Spinal trauma therapy Vertebral fractures and osteoporosis Neuropathic spine All throughout the book, the focus is on understanding the injury, and its implications and complications, through "an imaging approach.

Radiology , Musculoskeletal Imaging. Additional information Publisher Thieme. Content protection This content is DRM protected. Additional terms Terms of transaction. Ratings and reviews No one's rated or reviewed this product yet. To rate and review, sign in. Your review will post soon. There was an error posting your review.