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Three Part Question

In [adults patients presenting to the emergency department following spinal trauma with neurological signs] is [MRI better than CT] as [the primary radiographic investigation]

Clinical Scenario

Following a fall from a height a window cleaner aged 40 years arrives by ambulance to the emergency department. He complains that he can't feel his legs. Neurological examination shows both motor and sensory deficit in the lower limbs. You wonder if MRI would be better than CT as the primary radiological investigation

Search Strategy

Cochrane database of Systematic Reviews 2nd Quarter 2007. Medline 1950 to June week 2 using Ovid interface. EMBASE 1996 to 2007 week 25.
({exp spinal fractures OR spinal cord injuries OR lumbar frcature$ mp. OR thoracolumbar fracture$ OR exp spinal injuries} AND {exp computed tomography OR ct mp. OR exp magnetic resonance imaging OR magnet$ adj reson$ adj imag$ mp. OR MRI mp.} AND {exp neurologic manifestations} AND {neurological adj sign$ mp. OR neurologic$ adj deficit$ mp.}) LIMIT to english language. LIMIT to humans

Search Outcome

308 papers were found of which none were relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

No papers were found specific to the original clinical question. Several papers that were found describing the use of MRI in spinal trauma, discussed the use of MRI following CT and X-ray imaging in pateints with spinal cord injury, however, they did not investigate which imaging modality is most beneficial as the initial investigation in patients with suspected spinal cord injury following thoracolumbar trauma. MRI is superior to CT and plain film X-ray in determining whether concominant soft tissue injuries have been sustained, including vertebral discs, ligaments, epidural space, and vessels and also to directly asses the spinal cord.

Clinical Bottom Line

No evidence suggests that MRI is better than CT as the initial investigative imaging modality in suspected thoracolumbar fracture with neurological signs

References

1. Kerslake RW, Jaspan T, Worthington BS Magnetic resonance imaging of spinal trauma The British Journal of Radiology 1991;64:386-402
2. Wittenberg RH, Boetel U, Beyer HK Magnetic resonance imaging and computer tomography of acute spinal trauma General orthopaedics 1989;260:176-185