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. 2014 Oct;7(4):251-5.
doi: 10.4103/0974-2700.142611.

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

Iyore Ao James  1 , Ahmad Moukalled  2 , Elizabeth Yu  3 , David B Tulman  4 , Sergio D Bergese  5 , Christian D Jones  1 , Stanislaw Pa Stawicki  1 , David C Evans  1
Affiliations

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

Iyore Ao James et al. J Emerg Trauma Shock. 2014 Oct.

Abstract

Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

Keywords: Blunt trauma; cervical spine CT and MRI; obtunded.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Methodology for identification of relevant quality studies
Figure 2
Figure 2
Evaluations, results, and interventions in included patients. CS-CT: Cervical spine computed tomography; CS-MRI: Cervical spine magnetic resonance imaging
Figure 3
Figure 3
Simplified algorithm for the evaluation of cervical spine injury in the obtunded blunt trauma patient. CS-CT: Cervical spine computed tomography; CS-MRI: Cervical spine magnetic resonance imaging
See this image and copyright information in PMC

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