Introduction: The majority of spinal injuries occur secondary to blunt trauma and patients with significant blunt trauma must be assumed to have an unstable spinal injury until complete radiological and clinical assessment. MRI scans are highly sensitive but can be logistically difficult to perform in trauma patients, prolonging spinal immobilization unnecessarily. In this study we investigated the efficacy of MRI scans in changing patient management in blunt trauma patients, and the clinical and CT findings indicating for an MRI spine.

Material and Methods: This is a retrospective study of patients with significant blunt trauma who had MRI of the spine performed between 2018 to 2023 in the National University Hospital, Singapore. Indications for an MRI spine in our centre include the presence of spinal fractures on CT scan, neurological deficits, obtunded patient, tenderness over the spine on physical examination and underlying spine ankylosing conditions. AO spine fracture classification was used in classifying fracture morphology. We defined a stable fracture as AO type A0 cervical or thoracolumbar fracture. Change in patient management was defined as MRI scan leading to decision for surgery being done on patient.

Results: In total 539 patients, 135 (25%) female and 404 (75%) males, were identified who had MRI spine performed for spinal clearance. Of these, 234 (43.6%) led to change in management. On multivariate analysis, the presence of a potentially unstable fracture (p<0.01) and the presence of a neurological deficit (p<0.01) were found to be significant predictors of an MRI scan leading to change in management. Of note, when using the presence of a potentially unstable fracture and/or neurological deficit as a criteria for performing an MRI, 234/419 (55.9%) of scans led to a change in management, while in patients who did not meet this criteria 0/110(0.05)% of MRI scans led to a change in management.

Conclusion: An MRI scan may have no additional benefit in blunt trauma patients with no CT evidence of unstable fractures or neurological deficit.