Is MRI required to assess CT-negative traumatic cervical spine tenderness without focal neurologic deficit?.

Abstract

OBJECTIVES: Acute cervical spine injury is an uncommon but serious sequela of blunt trauma. Patients presenting with multi-trauma to the Emergency Department usually receive CT imaging for cervical spine clearance; however, many of these patients have ongoing pain despite a negative CT and proceed to an MRI. This can entail delays in care, transfer between hospitals, prolonged periods of cervical spine immobilisation, and increased healthcare costs. The aim of the study is to identify the rate of acute cervical spine injury detected on MRI following negative CT and the impact of these findings on subsequent patient management. METHOD(S): A retrospective analysis was conducted to identify adults presenting with blunt trauma from 2015 to 2023 who underwent MRI following a negative CT for possible cervical spine injury. RESULT(S): Of 849 patients who proceeded to MRI after a negative CT, 161 (19.0%) demonstrated evidence of cervical spine injury on MRI. 19 patients (11.8% of patients with positive findings; 2.2% of the overall cohort) had radiological injuries which were unstable or potentially unstable. 70 patients (8.3% of all patients who proceeded to MRI, 43.5% of those with abnormal findings) had a change in management based on MRI findings. In most cases, this was a hard collar with no need for surgery. 7 patients in the cohort (0.82%) required acute neurosurgical intervention. Patients with positive findings were older (OR 1.01 (1.01-1.02), p = 0.003) and less likely to have had a motor vehicle accident (OR 0.69 (0.48-0.997), p = 0.048). Increasing age and focal neurology were predictors of need for acute neurosurgical intervention. CONCLUSION(S): MRI for evaluation of suspected cervical cord injury has low yield for alert patients following blunt trauma with a negative CT, with a minority of patients requiring change in management and very few proceeding to acute neurosurgical intervention. More judicious patient selection including consideration of age, mechanism and presence of neurology may improve resource use and avoid unnecessarily prolonged immobilisation.Copyright © 2026 British Trauma Society. Published by Elsevier Ltd. All rights reserved.