Learning objectives
To demonstrate how Computed Tomography and Magnetic Resonance Imaging complement each other in the assessment of traumatic cervico-thoracic spinal injuries.
To suggest a systematic approach for their combined interpretation.
Background
Computed Tomography is usually the first imaging modality in the assessment of a potential traumatic spinal injury,
particularly in demonstrating injuries of the bony skeleton.
Magnetic Resonance Imaging adds vital information regarding the integrity of the pre-vertebral soft tissues,
intervertebral disc and spinal ligamentous structures.
This will determine the stability of the injury,
but more importantly will aid in the formulation of a management plan,
both conservative,
surgical and the potential surgical approach.
Figures 1 and 2 demonstrate the normal spinal anatomy on Computed Tomography....
Findings and procedure details
We review the cervico-thoracic spinal injuries using Computed Tomography and Magnetic Resonance Imaging presenting to our Tertiary Trauma Centre,
discussing the pertinent findings and reporting approach,
with reference to their surgical relevance.
This includes intervertebral disc disruption,
anterior and posterior longitudinal ligament injury,
ligamentum flavum and interspinous ligament injury,
epidural haematoma,
facet joint dislocations and common traumatic vertebral fractures.
Figures 4 and 5 demonstratebilateral facet joint dislocation at C5/6 level,
with intervertebral disc herniation into the spinal canal and spinal cord injury.
Figure 6 demonstrates...
Conclusion
Knowledge of the potential traumatic bone and soft tissue injuries and their imaging characteristics is paramount in cross-sectional image interpretation.
This combined cross-sectional approach and a systematic methodology are important,
in order to increase reporting accuracy,
with particular reference to the spinal surgical requirements.
Personal information
Dr Asimenia Mermekli
Specialist Registrar in Clinical Radiology
Oxford University Hospitals NHS Trust,
UK
DrKarenPartington
Consultant Musculoskeletal RadiologistHead of School Oxford Radiology Training Programme
Oxford University Hospitals NHS Trust,
UK
References
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Benedetti P F et al.MR Imaging Findings in Spinal Ligamentous Injury.AJR:175,
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American College of Radiology ACR Appropriateness Criteria®,
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Bernestein M P et al.
Cervical Spine Trauma: Pearls and Pitfalls.
2012 ARRS Categorical Course
https://www.e-lfh.org.uk/programmes/radiology