MR imaging of suspected acute spinal instability

Area of Science:

• Orthopedics
• Radiology
• Spinal Surgery

Background:

• Acute vertebral instability poses diagnostic challenges.
• Conventional radiography may underestimate injury severity.
• Early and accurate diagnosis is crucial for patient management.

Purpose of the Study:

• To evaluate the efficacy of acute magnetic resonance imaging (MRI) in diagnosing vertebral instability.
• To compare MRI findings with plain radiography and operative results.
• To determine the role of indirect MRI signs in assessing spinal injuries.

Main Methods:

• Twenty-two patients with suspected acute vertebral instability underwent imaging within 48 hours of injury.
• Standard imaging included plain radiographs, T1-weighted gradient echo (GE), and STIR MRI sequences.
• Two radiologists independently assessed MRI scans for bony or soft tissue disruption.

Main Results:

• MRI identified radiological instability in 16 patients, five more than plain films alone.
• Operative confirmation of instability was achieved in 10 patients.
• Indirect signs like soft tissue hemorrhage were noted, with ligamentous discontinuity being a key indicator.

Conclusions:

• Acute MRI is a rapid and accurate tool for evaluating most unstable spinal injuries.
• MRI offers superior sensitivity compared to plain radiography for detecting vertebral instability.
• This imaging modality can obviate the need for further investigations in acute settings.