Surface coil MR of spinal trauma: preliminary experience

Nineteen fractured vertebral bodies involving the spine from C1 to L2 in 14 patients were imaged with a 0.6-T magnet using prototypical surface coils. Ten of these patients were studied within the first week of trauma. CT and plain films are superior to MR in detecting fractures and identifying the origin of displaced fragments in cases of extensive comminution. However, all body fractures and most posterior element fractures in the thoracolumbar spine were visible on MR. Fractures involving the cervical neural arch were difficult to detect on transverse section without CT correlation. Our results indicate that MR can probably replace CT in the thoracolumbar region. MR is superior to CT in demonstrating ligamentous injury and trauma to the disk. Unlike CT, MR shows the relation of the thecal sac and spinal cord to retropulsed fragments and epidural hematoma. MR also visualizes cord parenchyma; two cases of cord hemorrhage were not seen on CT. Even at this early stage of development, surface coil MR promises to become important in the evaluation of spinal trauma, not only in assessing the integrity of the spinal canal and cord, but in separating stable from unstable fractures on the basis of disruption of the posterior ligaments and elements. Additionally, the demonstration of rupture of specific ligaments may have an impact on surgical management.