Efficacy of magnetic resonance imaging in the evaluation of posterior cervical spine fractures

Study Design. A retrospective study using two independent, blinded musculoskeletal radiologists to evaluate the sensitivity, specificity, and predictive value of cervical spine magnetic resonance imaging in detecting posterior element fractures of the cervical spine. Objective. To evaluate the sensitivity, specificity, and predictive value of magnetic resonance imaging, using computed tomographic scanning as the gold standard, in the diagnosis of posterior element cervical spine fractures. Summary of Background Data. Few investigators have evaluated the accuracy of magnetic resonance imaging in determination of cervical spine fractures. Methods. From January 1994 through June 1996, 75 cervical spine fractures in 32 patients were confirmed by computed tomography. Two musculoskeletal radiologists who were blinded to the clinical history and presence or absence of cervical injury among the study population, independently evaluated each cervical magnetic resonance image recording the presence or absence of soft tissue or bony injury. Results. The overall sensitivity and specificity rates for the diagnosis of a posterior element fracture by magnetic resonance imaging was 11.5% and 97.0%, respectively. The positive predictive value for this group was 83%, and the negative predictive value was 46%. In reference to anterior fractures, the sensitivity was 36.7% and the specificity 98%. Positive and negative predictive values were 91.2% and 64%, respectively. Conclusions. Magnetic resonance imaging was not effective in recognizing bony injury to the cervical spine and in particular was not as sensitive or as specific as computed tomography in identifying cervical spinal fractures. Computed tomography remains the study of choice for the detection and precise classification of bony injuries to the cervical region, especially when plain radiographs are difficult to evaluate, Magnetic resonance imaging, although not as effective as computed tomography in defining specific bony disorders, remains the gold standard in the evaluation of spinal cord injury, occult vascular injury, and intervertebral disc disruption (hyperextension injury), including herniation and other soft tissue disorders (hematoma, ligament tear).