Utility of MRI in Blunt Trauma Patients with a Normal Cervical Spine CT and Persistent Midline Neck Pain on Palpation

Abstract

Introduction: The blunt trauma patient with a normal neurologic exam, and persistent midline cervical spine tenderness remains a diagnostic challenge. The patient with a symptomatic neck can be subsequently treated with flexion-extension cervical spine X-rays, MRI of the cervical spine, or no further imaging. Methods: This is a single center, retrospective study that spanned five years. Our current protocol for cervical spine clearance is described, which utilizes neck MRI for the trauma patients with persistent midline neck tenderness, a normal neurologic exam, and a normal CT of the neck. These symptomatic neck patients were identified from the institution's radiology database of patients that had both a CT and an MRI. Results: There were 6237 patients identified during the time of the study, and 81 were found to have both a CT and an MRI of the cervical spine for a symptomatic neck without a neurological deficit. There were 4 patients identified that had a normal CT, and subsequently had a new finding on the MRI scan; all were discharged with their cervical collar on with Spine Specialist followup. Conclusion: In 4.94% of our patients, the MRI had significant findings that changed the management of the patient. We will continue to perform cervical MRI in our symptomatic neck patients after blunt trauma with a normal cervical spine CT.