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Clinical significance of “positive” cervical spine MRI findings following a negative CT



To review and analyze the clinical significance of positive acute traumatic findings seen on MRI of the cervical spine (MRCS) following a negative CT of the cervical spine (CTCS) for trauma.


We performed a sub-cohort analysis of 54 patients with negative CTCS and a positive MRCS after spine trauma from the previous multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Both CTCS and MRCS were independently reviewed by two emergency radiologists and two spine surgeons. The surgeons also commented on the clinical significance of the traumatic findings seen on MRCS and grouped them into unstable, potentially unstable, and stable injuries.


Among 35 unevaluable patients, MRCS showed one unstable (hyperextension) and two potentially unstable (hyperflexion) injuries. Subtle findings were seen on CTCS in 2 of 3 patients upon careful retrospective review that would have suggested these injuries. Of 19 patients presenting with cervicalgia, 2/5 (40%) patients with neurological deficit demonstrated clinically significant findings on MRCS with predisposing factors seen on CT. None of the 14 patients with isolated cervicalgia and no neurological deficit had clinically significant findings on their MRCS.


While CTCS is adequate for clearing the cervical spine in patients with isolated cervicalgia, MRCS can play a critical role in patients with neurological deficits and normal CTCS. Clinically significant traumatic findings were seen in 8.5% of unevaluable patients on MRCS, though these injuries in fact could be identified on the CT in 2 of 3 patients upon careful retrospective review.

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  1. Sparke A, Voss S, Benger J (2013) The measurement of tissue interface pressures and changes in jugular venous parameters associated with cervical immobilisation devices: a systematic review. Scand J Trauma Resusc Emerg Med 21:81.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Young AJ, Wolfe L, Tinkoff G, Duane TM (2015) Assessing incidence and risk factors of cervical spine injury in blunt trauma patients using the National Trauma Data Bank. Am Surg 81(9):879–883

    Article  Google Scholar 

  3. Alessandrino F, Bono CM, Potter CA, Harris MB, Sodickson AD, Khurana B (2019) Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance. Emerg Radiol 26(4):409–416.

    Article  PubMed  Google Scholar 

  4. Todd NV, Skinner D, Wilson-MacDonald J. Secondary neurological deterioration in traumatic spinal injury: data from medicolegal cases. Bone Jt J. 2015;97-B(4):527–531. doi:

  5. Jalilvand A, Velmahos G, Baugh C, Schoenfeld A, Harris M, Khurana B (2021) Impact of MRI to clear the cervical spine after a negative CT for suspected spine trauma. Emerg Radiol.

    Article  PubMed  Google Scholar 

  6. Malhotra A, Durand D, Wu X et al (2018) Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT. Eur Radiol 28(7):2823–2829.

    Article  PubMed  Google Scholar 

  7. Schoenfeld AJ, Bono CM, McGuire KJ, Warholic N, Harris MB. Computed tomography alone versus computed tomography and magnetic resonance imaging in the identification of occult injuries to the cervical spine: a meta-analysis. J Trauma. 2010;68(1):109–113; discussion 113–114. doi:

  8. Malhotra A, Wu X, Kalra VB et al (2017) Utility of MRI for cervical spine clearance after blunt traumatic injury: a meta-analysis. Eur Radiol 27(3):1148–1160.

    Article  PubMed  Google Scholar 

  9. Badhiwala JH, Lai CK, Alhazzani W et al (2015) Cervical spine clearance in obtunded patients after blunt traumatic injury: a systematic review. Ann Intern Med 162(6):429–437.

    Article  PubMed  Google Scholar 

  10. Muchow RD, Resnick DK, Abdel MP, Munoz A, Anderson PA (2008) Magnetic resonance imaging (MRI) in the clearance of the cervical spine in blunt trauma: a meta-analysis. J Trauma 64(1):179–189.

    Article  PubMed  Google Scholar 

  11. James IA, Moukalled A, Yu E et al (2014) A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT. J Emerg Trauma Shock 7(4):251–255.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bush L, Brookshire R, Roche B et al (2016) Evaluation of cervical spine clearance by computed tomographic scan alone in intoxicated patients with blunt trauma. JAMA Surg 151(9):807–813.

    Article  PubMed  Google Scholar 

  13. Fisher BM, Cowles S, Matulich JR, Evanson BG, Vega D, Dissanaike S (2013) Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients? Am J Surg 206(6):987–994.

    Article  PubMed  Google Scholar 

  14. Tan LA, Kasliwal MK, Traynelis VC (2014) Comparison of CT and MRI findings for cervical spine clearance in obtunded patients without high impact trauma. Clin Neurol Neurosurg 120:23–26.

    Article  PubMed  Google Scholar 

  15. Kanji HD, Neitzel A, Sekhon M, McCallum J, Griesdale DE (2014) Sixty-four–slice computed tomographic scanner to clear traumatic cervical spine injury: systematic review of the literature. J Crit Care 29(2):314.e9-314.e13.

    Article  Google Scholar 

  16. Raza M, Elkhodair S, Zaheer A, Yousaf S (2013) Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan–a meta-analysis and cohort study. Injury 44(11):1589–1595.

    Article  PubMed  Google Scholar 

  17. Pourtaheri S, Emami A, Sinha K et al (2014) The role of magnetic resonance imaging in acute cervical spine fractures. Spine J 14(11):2546–2553.

    Article  PubMed  Google Scholar 

  18. Como JJ, Thompson MA, Anderson JS, et al. Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma?: J Trauma Inj Infect Crit Care. 2007;63(3):544–549. doi:

  19. Menaker J, Philp A, Boswell S, Scalea TM (2008) Computed tomography alone for cervical spine clearance in the unreliable patient—are we there yet? J Trauma Inj Infect Crit Care 64(4):898–904.

    Article  Google Scholar 

  20. Simon JB, Schoenfeld AJ, Katz JN, et al. Are “normal” multidetector computed tomographic scans sufficient to allow collar removal in the trauma patient?: J Trauma Inj Infect Crit Care. 2010;68(1):103–108. doi:

  21. Tomycz ND, Chew BG, Chang Y-F et al (2008) MRI is unnecessary to clear the cervical spine in obtunded/comatose trauma patients: the four-year experience of a level I trauma center: J Trauma Inj Infect Crit Care 64(5):1258–1263.

    Article  Google Scholar 

  22. Maung AA, Johnson DC, Barre K et al (2017) 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 82(2):263–269.

    Article  PubMed  Google Scholar 

  23. Bransford RJ, Alton TB, Patel AR, Bellabarba C (2014) Upper cervical spine trauma. J Am Acad Orthop Surg 22(11):718–729.

    Article  PubMed  Google Scholar 

  24. Inaba K, Byerly S, Bush LD et al (2016) Cervical spinal clearance: a prospective Western Trauma Association Multi-institutional Trial. J Trauma Acute Care Surg 81(6):1122–1130.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Lin J-L, Samuel S, Gray R et al (2017) Occult subaxial cervical disco-ligamentous injuries in computer tomography negative trauma patients. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 26(4):1277–1283.

    Article  Google Scholar 

  26. Rao SK, Wasyliw C, Nunez DB. Spectrum of imaging findings in hyperextension injuries of the neck. RadioGraphics. Radiological Society of North America; 2005;25(5):1239–1254. doi:

  27. Gebauer G, Osterman M, Harrop J, Vaccaro A (2012) Spinal cord injury resulting from injury missed on CT scan: the danger of relying on CT alone for collar removal. Clin Orthop 470(6):1652–1657.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Green JD, Harle TS, Harris JH (1981) Anterior subluxation of the cervical spine: hyperflexion sprain. AJNR Am J Neuroradiol 2(3):243–250

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Winslow JE, Hensberry R, Bozeman WP, Hill KD, Miller PR (2006) Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma 61(3):686–687.

    Article  PubMed  Google Scholar 

  30. Molière S, Zaragori-Benedetti C, Ehlinger M, Le Minor J-M, Kremer S, Bierry G. Evaluation of paraspinal fat pad as an indicator of posterior ligamentous complex injury in cervical spine trauma. Radiology. Radiological Society of North America; 2017;282(3):790–797. doi:

  31. Pizones J, Izquierdo E, Sánchez-Mariscal F, Zúñiga L, Álvarez P, Gómez-Rice A (2012) Sequential damage assessment of the different components of the posterior ligamentous complex after magnetic resonance imaging interpretation: prospective study 74 traumatic fractures. Spine 37(11):E662

    Article  Google Scholar 

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Correspondence to Bharti Khurana.

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Bharti Khurana

GE Health Care Research Grant;

Book Royalties from Cambridge University Press;

Section Editor Royalties, Emergency Radiology, UptoDate, Wolters Kluwer; and.

ROKIT Health Care, Consulting.

Christopher M. Bono

NASS/The Spine Journal

United Health Care, Consultant

Elsevier, royalties

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Khurana, B., Keraliya, A., Velmahos, G. et al. Clinical significance of “positive” cervical spine MRI findings following a negative CT. Emerg Radiol 29, 307–316 (2022).

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  • Spine trauma
  • CT of the cervical spine
  • MRI of the cervical spine
  • Spine stability