Cervical Spine MRI

This retrospective study attempted to determine the efficacy, indications, and outcomes of patients who had a cervical spine MRI.

The most common initial diagnoses included degenerative disk disease, acute disk herniation, and malignant tumors. Of the 87 patients involved in the reevaluation, MRI was followed by invasive medical therapy in 11 cases. Nine consisted of surgery, radiation therapy in one, and spinal cord stimulation in the other.

To assess the efficacy the researchers sent a patient questionaire to the subjects whose files were under review. Six patients reported their symptoms had disppeared, with 17 symptoms decreased, 35 symptoms were unchanged, and 25 conveyed that symptoms increased.

Twenty-one of the patients who underwent MRI had whiplash trauma. The researchers reflect on this occurrence:

"Patients with old whiplash trauma, and especially patients on long-term sick leave, dominated in our patient sample. The present findings confirmed the results of previous studies that there is no role for cervical spine MRI in patients with whiplash, unless the patient has neurologic symptoms."^2,3

Also of interest, the researchers determined if MRI was "justified" or "unjustified" in reviewing the earlier files. They determined criteria (which they claim, "cannot be regarded as official guidelines"), to assess the justification of performing a cervical spine MRI:

Justified Criteria:

• Known malignancy or unknown cervical mass.
• Sensory disturbance or paresis in one or both legs or clinical signs of myelopathy.
• Motor disturbance in arm (paresis or atrophy).
• Progressive or unchanged sensory disturbance in arm of more than one-month duration.

Unjustified Criteria

• Sensory disturbance in arm of less than 1-month duration.
• Chronic, stationary, or intermittent sensory disturbance in one arm of more than one-year duration.
• Previous cervical-spine MRI not showing serious disease and no progressive symptoms.

1. Isberg B, Joruf H, Svahn U, Westman L. Outcome of cervical spine MRI. Academic Radiology 1998; 5(suppl 2): S328-S332.
2. Voyvodic F, Dolinis J, Moore VM, et al. MRI of car occupants with whiplash injury. Neroradiology 1997;39:35-40.
3. Ronnen HR, de Korte PJ, Brink PR, van der Bijl HJ, Tonino AJ, Franke CL. Acute whiplash injury: is there a role for MR imaging? A prospective study of 100 patients. Radiology 1996;201: 93-96.