gms | German Medical Science

Introduction: Traumatic injuries of the cervical spine can be accompanied by significant neurological deficits and an impaired prognosis. Choosing the best therapy and prevention of secondary injuries relies on an adequate and reliable diagnostic. Discoligamentous injuries are often concomitant to cervical fractures or can appear as solitary lesions and still are diagnostic challenging. The aim of our study was to assess the sensitivity and specifity of CT and MR imaging for diagnosis of discoligamentous injuries.

Methods: In this retrospective study, only patients after subaxial cervical spine injuries with abnormal findings on initial CT or MR imaging were included. Vertebral body burst fractures and luxation injuries were excluded. Clinical data was extracted from in-house medical charts.

Results: In this retrospective study, a total of 24 patients, treated between 2012 and 2017 at our department, were included. 21 cases were examined with initial CT and followed MRI scan, 3 cases had only an MRI scan. Neurological status was unaffected within 10 patients, 6 showed injuries of cervical nerve roots, incomplete tetraplegia was observed in 6 patients, complete paraplegia/tetraplegia in 2. Primary CT was suspicious for discoligamentous injuries in 17 cases, MRI scan was followed in all these patients. Within 3 of these, no lesion was detected within MRI and flex/ext. x-ray films. In 4 cases, CT finding was primary negative, but MRI was performed due to neurological deficits, radicular pain or severe neck pain. In all of these cases, MRI revealed a discoligamentous injury. A total of only one MRI was confirmed false negative with gross instability in flex/ext. x-ray films and complete disc rupture shown during surgery. 3 CT scan were rated false positive and another 4 as false negative. 19 cases were treated surgically, one with external bracing and 4 patients with conservative therapy.

Conclusion: Beside an often accurate diagnostic quality of initial CT scans for bony injuries of the subaxial cervical spine after trauma, for the detection of discoligamentous injuries MRI is still superior. Despite the higher sensitivity of MRI, some cases will still need further clinical evaluation or dynamic motion studies via flexion-extension x-ray films.