Imaging of Blunt Cervical Spine Ligamentous Injuries: Bridging the Gap between Neuroradiologists and Neurosurgeons

Abstract

In a setting of acute spinal trauma, imaging delineates all osseous and soft-tissue injuries and helps to guide potential surgical intervention. CT is the technique of choice in the setting of acute trauma. However, MR imaging is integral in the assessment of traumatic spinal injury, specifically assessing discoligamentous structures otherwise not seen on CT. We describe the critical imaging parameters of cervical spine injuries in accordance with the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Spine classification system and its impact on neurosurgical management. T2 fat-saturation sagittal and coronal images are valuable in assessing cervical spine ligaments. MR imaging at 3T offers superior resolution than 1.5T. The AO Spine classification for cervical spine injuries is now widely used and is more robust and correlates well with MR imaging. Type A injuries can be managed conservatively. Type B injuries are potentially unstable. B1 osseous injuries alone can be managed conservatively. Anterior or posterior tension band injuries (B2/B3 type) are unstable and are considered for surgical intervention or halo immobilization. Type C injuries have marked ligamentous injury and often require surgery. Identifying key MR imaging findings and using the AO Spine classification system and a reporting template helps bridging the knowledge gap between neuroradiologists and neurosurgeons, in turn influencing patient management.Learning Objectives: To understand the nuances of critical imaging findings of cervical spine injuries in accordance with the AO classification: how to minimize errors in reports using a simple MR imaging reporting template or a checklist; incorporating a universally accepted nomenclature and terminologies to remove bias and ensure consistency in communication with neurosurgical teams; and bridging the knowledge gap between neuroradiologists and neurosurgeons in the management of blunt cervical spinal trauma