The cervical spine can be cleared without MRI after blunt trauma:A retrospective review of a single level 1 trauma center experience over 8 years

The newest CT scanners provide resolution comparable to MRIs leading many to question when and whether cervical spine MRIs are warranted. An 8 year retrospective review identified 241 patients who underwent CT scan and MRI of the cervical spine. The initial clinical examination, cervical spine CT scan, and cervical spine MRI were compared to identify cervical spine injuries that would have been missed had the MRI not been performed. The CT scans were normal in 153 patients, and abnormal in 88. Of the 88 abnormal CT scans, the MRIs were abnormal in 65, and normal in the other 23. The indications for MRI in patients with normal CT scans were neck pain, an abnormal neurologic examination, and/or altered mental status. Of the 13 patients with abnormal MRIs, none were pain free with a normal clinical examination. In the absence of focal signs of neurologic injury, the cervical spine can be cleared without a clinical exam or MRI if the cervical CT scan does not demonstrate injury or abnormality. •Current generation high resolution multidetector CT scanner images rival MRIs.•Cervical MRIs can identify ligamentous injury when a confrontational exam cannot be obtained.•A retrospective review of 241 patients who received cervical CT and MRI for trauma was performed.•In the absence of focal signs of neurologic injury, MRI is not needed if the cervical CT is normal.