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Imaging of Spinal Trauma with MRI: A Practical Guide

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Atlas of Emergency Imaging from Head-to-Toe

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Abstract

Traumatic spinal injuries are unfortunately common and are clinically important given their potential for severe morbidity and even mortality. Imaging plays a critical role in the evaluation of patients with acute spine trauma. While computed tomography (CT) is well established as the initial imaging modality for evaluating patients with known or suspected spinal trauma, emerging roles for magnetic resonance imaging (MRI) in guiding the emergent management and triage for patients continues to evolve. This review will focus on the added value and limitations of MRI in acute spinal trauma evaluation. Specifically, clinical and imaging indications for MRI will be reviewed. A structured approach to MRI for assessing spinal stability in the context of imaging-based classification systems will also be discussed, with emphasis on the AOSpine cervical subaxial and thoracolumbar classification schemes. MRI assessment of spinal canal contents, with emphasis on the injured spinal cord for both diagnostic and prognostic purposes, will be highlighted. Finally, the added value of MRI for assessing paraspinal soft-tissue injury, specifically for evaluation of whiplash-associated disorder, will be reviewed.

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References

  1. Izzo R, Popolizio T, Balzano RF, Pennelli AM, Simeone A, Muto M. Imaging of cervical spine traumas. Eur J Radiol. 2019;117:75–88.

    Article  PubMed  Google Scholar 

  2. Badhiwala JH, Lai CK, Alhazzani W, Farrokhyar F, Nassiri F, Meade M, et al. Cervical spine clearance in obtunded patients after blunt traumatic injury: a systematic review. Ann Intern Med. 2015;162(6):429–37.

    Article  PubMed  Google Scholar 

  3. National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. In: Birmingham UoAa, editor. 2017.

    Google Scholar 

  4. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal cord Med. 2011;34(6):535–46.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94–9.

    Article  CAS  PubMed  Google Scholar 

  6. Stiell IG, Laupacis A, Wells GA, Canadian CTH, Cervical-Spine SG. Indications for computed tomography after minor head injury. Canadian CT Head and Cervical-Spine Study Group. N Engl J Med. 2000;343(21):1570–1.

    Article  CAS  PubMed  Google Scholar 

  7. Bailitz J, Starr F, Beecroft M, Bankoff J, Roberts R, Bokhari F, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66(6):1605–9.

    PubMed  Google Scholar 

  8. Ghanta MK, Smith LM, Polin RS, Marr AB, Spires WV. An analysis of Eastern Association for the Surgery of Trauma practice guidelines for cervical spine evaluation in a series of patients with multiple imaging techniques. Am Surg. 2002;68(6):563–7. discussion 7-8

    PubMed  Google Scholar 

  9. Shah LM, Ross JS. Imaging of spine trauma. Neurosurgery. 2016;79(5):626–42.

    Article  PubMed  Google Scholar 

  10. Beckmann NM, West OC, Nunez D Jr, et al. ACR appropriateness criteria suspected spine trauma. J Am Coll Radiol: JACR. 2019;16(5S):S264–85.

    Article  PubMed  Google Scholar 

  11. Daffner RH, Hackney DB. ACR Appropriateness Criteria on suspected spine trauma. J Am Coll Radiol: JACR. 2007;4(11):762–75.

    Article  PubMed  Google Scholar 

  12. Wu X, Malhotra A, Geng B, Liu R, Abbed K, Forman HP, et al. Cost-effectiveness of magnetic resonance imaging in cervical cpine clearance of neurologically intact patients with blunt trauma. Ann Emerg Med. 2018;71(1):64–73.

    Article  PubMed  Google Scholar 

  13. Wu X, Malhotra A, Geng B, Kalra VB, Abbed K, Forman HP, et al. Cost-effectiveness of magnetic resonance imaging in cervical clearance of obtunded blunt trauma after a normal computed tomographic finding. JAMA Surg. 2018;153(7):625–32.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Malhotra A, Wu X, Kalra VB, Nardini HK, Liu R, Abbed KM, et al. Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis. Eur Radiol. 2017;27(3):1148–60.

    Article  PubMed  Google Scholar 

  15. Onoue K, Farris C, Burley H, Sung E, Clement M, Abdalkader M, et al. Role of cervical spine MRI in the setting of negative cervical spine CT in blunt trauma: critical additional information in the setting of clinical findings suggestive of occult injury. J Neuroradiol Journal de neuroradiologie. 2019;48(3):164–9.

    Article  PubMed  Google Scholar 

  16. Maung AA, Johnson DC, Barre K, Peponis T, Mesar T, Velmahos GC, et al. Cervical spine MRI in patients with negative CT: a prospective, multicenter study of the research consortium of new england centers for trauma (ReCONECT). J Trauma Acute Care Surg. 2017;82(2):263–9.

    Article  PubMed  Google Scholar 

  17. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma. 2011;28(8):1401–11.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Haefeli J, Mabray MC, Whetstone WD, Dhall SS, Pan JZ, Upadhyayula P, et al. Multivariate analysis of MRI biomarkers for predicting neurologic impairment in cervical spinal cord injury. AJNR Am J Neuroradiol. 2017;38(3):648–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Li Z, Chen YA, Chow D, Talbott J, Glastonbury C, Shah V. Practical applications of CISS MRI in spine imaging. Eur J Radiol Open. 2019;6:231–42.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Koontz NA, Wiggins RH 3rd, Mills MK, McLaughlin MS, Pigman EC, Anzai Y, et al. Less is more: efficacy of rapid 3D-T2 SPACE in ED patients with acute atypical low back pain. Acad Radiol. 2017;24(8):988–94.

    Article  PubMed  Google Scholar 

  21. Chokshi FH, Sadigh G, Carpenter W, Allen JW. Diagnostic quality of 3D T2-SPACE compared with T2-FSE in the evaluation of cervical spine MRI anatomy. AJNR Am J Neuroradiol. 2017;38(4):846–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Wang M, Dai Y, Han Y, Haacke EM, Dai J, Shi D. Susceptibility weighted imaging in detecting hemorrhage in acute cervical spinal cord injury. Magn Reson Imaging. 2011;29(3):365–73.

    Article  PubMed  Google Scholar 

  23. Biering-Sorensen F, Alai S, Anderson K, Charlifue S, Chen Y, DeVivo M, et al. Common data elements for spinal cord injury clinical research: a national institute for neurological disorders and Stroke project. Spinal Cord. 2015;53(4):265–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Goradia D, Linnau KF, Cohen WA, Mirza S, Hallam DK, Blackmore CC. Correlation of MR imaging findings with intraoperative findings after cervical spine trauma. AJNR Am J Neuroradiol. 2007;28(2):209–15.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Rihn JA, Yang N, Fisher C, Saravanja D, Smith H, Morrison WB, et al. Using magnetic resonance imaging to accurately assess injury to the posterior ligamentous complex of the spine: a prospective comparison of the surgeon and radiologist. J Neurosurg Spine. 2010;12(4):391–6.

    Article  PubMed  Google Scholar 

  26. Pizones J, Zuniga L, Sanchez-Mariscal F, Alvarez P, Gomez-Rice A, Izquierdo E. MRI study of post-traumatic incompetence of posterior ligamentous complex: importance of the supraspinous ligament. Prospective study of 74 traumatic fractures. Eur Spine J : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2012;21(11):2222–31.

    Article  Google Scholar 

  27. Rihn JA, Fisher C, Harrop J, Morrison W, Yang N, Vaccaro AR. Assessment of the posterior ligamentous complex following acute cervical spine trauma. J Bone Joint Surg Am. 2010;92(3):583–9.

    Article  PubMed  Google Scholar 

  28. White AA 3rd, Johnson RM, Panjabi MM, Southwick WO. Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Relat Res. 1975;109:85–96.

    Article  Google Scholar 

  29. Chhabra HS, Kaul R, Kanagaraju V. Do we have an ideal classification system for thoracolumbar and subaxial cervical spine injuries: what is the expert’s perspective? Spinal Cord. 2015;53(1):42–8.

    Article  CAS  PubMed  Google Scholar 

  30. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;189:65–76.

    Google Scholar 

  31. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 1994;3(4):184–201.

    Article  CAS  Google Scholar 

  32. Vaccaro AR, Lehman RA Jr, Hurlbert RJ, Anderson PA, Harris M, Hedlund R, et al. A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine. 2005;30(20):2325–33.

    Article  PubMed  Google Scholar 

  33. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA Jr, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine. 2007;32(21):2365–74.

    Article  PubMed  Google Scholar 

  34. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine. 2013;38(23):2028–37.

    Article  PubMed  Google Scholar 

  35. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2016;25(7):2173–84.

    Article  Google Scholar 

  36. Abedi A, Mokkink LB, Zadegan SA, Paholpak P, Tamai K, Wang JC, et al. Reliability and validity of the AOSpine thoracolumbar injury classification system: a systematic review. Global Spine J. 2019;9(2):231–42.

    Article  PubMed  Google Scholar 

  37. Schnake KJ, Schroeder GD, Vaccaro AR, Oner C. AO spine classification systems (Subaxial, Thoracolumbar). J Orthop Trauma. 2017;31(Suppl 4):S14–23.

    Article  PubMed  Google Scholar 

  38. Pizones J, Izquierdo E, Sanchez-Mariscal F, Alvarez P, Zuniga L. Re: Vaccaro AR, Rihn JA, Saravanja D, et al. Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. Spine 2009;34:E841-7. Spine. 2010;35(8):929–30. author reply 30

    Article  PubMed  Google Scholar 

  39. Vaccaro AR, Schroeder GD, Kepler CK, Cumhur Oner F, Vialle LR, Kandziora F, et al. The surgical algorithm for the AOSpine thoracolumbar spine injury classification system. Eur Spine J: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2016;25(4):1087–94.

    Article  Google Scholar 

  40. Pizones J, Izquierdo E, Sanchez-Mariscal F, Zuniga L, Alvarez P, Gomez-Rice A. Sequential damage assessment of the different components of the posterior ligamentous complex after magnetic resonance imaging interpretation: prospective study 74 traumatic fractures. Spine. 2012;37(11):E662–7.

    Article  PubMed  Google Scholar 

  41. Reina MA, Lirk P, Puigdellivol-Sanchez A, Mavar M, Prats-Galino A. human lumbar ligamentum flavum anatomy for epidural anesthesia: reviewing a 3D MR-based interactive model and postmortem samples. Anesth Analg. 2016;122(3):903–7.

    Article  CAS  PubMed  Google Scholar 

  42. Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM. Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations. Spine. 1999;24(12):1210–7.

    Article  CAS  PubMed  Google Scholar 

  43. Brichko L, Giddey B, Tee J, Niggemeyer L, Fitzgerald M. Cervical spine traumatic epidural haematomas: incidence and characteristics. Emerg Med Australasia : EMA. 2018;30(3):359–65.

    Article  PubMed  Google Scholar 

  44. Sklar EM, Post JM, Falcone S. MRI of acute spinal epidural hematomas. J Comput Assist Tomogr. 1999;23(2):238–43.

    Article  CAS  PubMed  Google Scholar 

  45. Lawrence DA, Trotta B, Shen FH, Druzgal JT, Fox MG. Imaging characteristics of cervical spine extra-arachnoid fluid collections managed conservatively. Skelet Radiol. 2016;45(9):1285–9.

    Article  Google Scholar 

  46. Haines DE, Harkey HL. al-Mefty O. The “subdural” space: a new look at an outdated concept. Neurosurgery. 1993;32(1):111–20.

    Article  CAS  PubMed  Google Scholar 

  47. Horn EM, Bristol RE, Feiz-Erfan I, Beres EJ, Bambakidis NC, Theodore N. Spinal cord compression from traumatic anterior cervical pseudomeningoceles. Report of three cases. J Neurosurg Spine. 2006;5(3):254–8.

    Article  PubMed  Google Scholar 

  48. Talbott JFHJ, Ferguson AR, Bresnahan JC, Beattie M, Dhall SS. Magnetic resonance imaging for assessing injury severity and prognosis in acute traumatic spinal cord injury. Imaging Clin N Am. 2018; In Press

    Google Scholar 

  49. Talbott JF, Whetstone WD, Readdy WJ, Ferguson AR, Bresnahan JC, Saigal R, et al. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine. 2015;23(4):495–504.

    Article  PubMed  Google Scholar 

  50. Schaefer DM, Flanders A, Northrup BE, Doan HT, Osterholm JL. Magnetic resonance imaging of acute cervical spine trauma. Correlation with severity of neurologic injury. Spine. 1989;14(10):1090–5.

    Article  CAS  PubMed  Google Scholar 

  51. Leypold BG, Flanders AE, Burns AS. The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury. AJNR Am J Neuroradiol. 2008;29(5):1012–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Aarabi B, Simard JM, Kufera JA, Alexander M, Zacherl KM, Mirvis SE, et al. Intramedullary lesion expansion on magnetic resonance imaging in patients with motor complete cervical spinal cord injury. J Neurosurg Spine. 2012;17(3):243–50.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Farhadi HF, Kukreja S, Minnema A, Vatti L, Gopinath M, Prevedello L, et al. Impact of admission imaging findings on neurological outcomes in acute cervical traumatic spinal cord injury. J Neurotrauma. 2018;35(12):1398–406.

    Article  PubMed  Google Scholar 

  54. 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;243(3):820–7.

    Article  PubMed  Google Scholar 

  55. Kurpad S, Martin AR, Tetreault LA, Fischer DJ, Skelly AC, Mikulis D, et al. Impact of baseline magnetic resonance imaging on neurologic, functional, and safety outcomes in patients with acute traumatic spinal cord injury. Global Spine J. 2017;7(3 Suppl):151S–74S.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Fehlings MG, Martin AR, Tetreault LA, Aarabi B, Anderson P, Arnold PM, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the role of baseline magnetic resonance imaging in clinical decision making and outcome prediction. Global Spine J. 2017;7(3 Suppl):221S–30S.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Anderson SE, Boesch C, Zimmermann H, Busato A, Hodler J, Bingisser R, et al. Are there cervical spine findings at MR imaging that are specific to acute symptomatic whiplash injury? A prospective controlled study with four experienced blinded readers. Radiology. 2012;262(2):567–75.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, UCSF and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA

    Jason F. Talbott, Vinil Shah & Jared Narvid

  2. Brain and Spine Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA

    Jason F. Talbott, John F. Burke & Sanjay S. Dhall

  3. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    John F. Burke & Sanjay S. Dhall

  4. Department of Radiology, University of Colorado Anschutz Medical Campus, Denver, CO, USA

    Andrew Callen

Authors
  1. Jason F. Talbott
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  2. John F. Burke
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  3. Andrew Callen
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  4. Vinil Shah
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  5. Jared Narvid
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  6. Sanjay S. Dhall
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Corresponding author

Correspondence to Jason F. Talbott .

Editor information

Editors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Michael N. Patlas

  2. NYU Langone Hospital - Long Island and the NYU Long Island School of Medicine, Mineola, NY, USA

    Douglas S. Katz

  3. Department of Medical, Surgical and Experimental Sciences, University of Medicine and Surgery, Sassari, Italy

    Mariano Scaglione

Section Editor information

  1. Department of Diagnostic Imaging, Ottawa Hospital Research Institute OHRI, Ottawa, Ontario, Canada

    Carlos Torres

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Talbott, J.F., Burke, J.F., Callen, A., Shah, V., Narvid, J., Dhall, S.S. (2022). Imaging of Spinal Trauma with MRI: A Practical Guide. In: Patlas, M.N., Katz, D.S., Scaglione, M. (eds) Atlas of Emergency Imaging from Head-to-Toe. Springer, Cham. https://doi.org/10.1007/978-3-030-92111-8_13

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  • DOI: https://doi.org/10.1007/978-3-030-92111-8_13

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