Cervical Spine Trauma

The use of flexion and extension MRI in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects

Emergency Radiology
(October 2002)  9: 249–253
Vincenzo Giuliano, Concetta Giuliano, Fabio Pinto, Mariano Scaglione

Background information from Dan Murphy

1. Subacute whiplash patients have about half the range of motion when compared to normal control subjects.

2. In this study, the normal control subjects showed that 4 percent had hypolordosis and 2 percent had disk herniations.

3. In this study, the whiplash injured patients showed that 98 percent had hypolordosis and 28 percent had disk herniations.

4. These authors note that plain film lateral flexion and extension views to evaluate soft tissue and diskoli-gamentous injuries are poor, that videofluoroscopy is better, and that flexion and extension magnetic resonance imaging (MRI) is best. In this study, the flexion/extension MRI’s showed much pathology that was not seen with plain radiographs.

5. Flexion/extension MRI shows the “pattern of segmental motion.”

6. The “pattern of segmental motion” is normal in non-traumatic hypolordosis and non-traumatic disk herniation, but abnormal in post-traumatic hypo-lordosis.

7. In this study, 12–14 weeks after injury, the whiplash patients complained of neck pain, headache, arm pain and arm numbness. This is more evidence that not all patients recover in a period of 6-8 weeks.

8. Flexion and extension MRI optimizes the functional significance of disk herniations in symptomatic patients, offering a distinct advantage to conventional MRI examinations performed in the neutral position.

9. These authors recommend flexion and extension MRI’s in the clinical setting of subacute cervical spine trauma (more than 12 weeks following injury). The clinical indication includes persistent neurologic deficit and clinical evidence of instability despite normal radiographs.

10.[Recent studies are showing that weight-bearing flexion/extension MRI’s show more soft tissue pathology. Life Chiropractic College West now has an upright weight-bearing MRI unit: (510) 780-4500.]

A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit www.danmurphydc.com.

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