TRAUMA/ORIGINAL RESEARCH Cervical Spine Magnetic Resonance Imaging in Alert, Neurologically Intact Trauma Patients With Persistent Midline Tenderness and Negative Computed Tomography Results Helen M. Ackland, MHSc, Peter A. Cameron, MBBS, MD, Dinesh K. Varma, MBBS, MD, Gregory J. Fitt, MBBS, D. James Cooper, MD, BS, Rory Wolfe, BSc, PhD, Gregory M. Malham, BSc, MB ChB, Jeffrey V. Rosenfeld, MBBS, MD, Owen D. Williamson, MBBS, GradDipClinEpi, Susan M. Liew, MBBS From the National Trauma Research Institute (Ackland, Cameron, Rosenfeld), the Emergency and Trauma Centre (Cameron), the Department of Radiology (Varma), the Intensive Care Department (Cooper), the Department of Neurosurgery (Malham, Rosenfeld), and the Department of Orthopaedic Surgery (Liew), The Alfred Hospital, Melbourne, Australia; the Department of Epidemiology and Preventive Medicine (Ackland, Cameron, Cooper, Wolfe, Williamson) and Department of Surgery (Varma, Malham, Rosenfeld), Monash University, Melbourne, Australia; and the Department of Radiology, Austin Health, Melbourne, Australia, and the Department of Medicine, University of Melbourne, Melbourne, Australia (Fitt). Study objective: We aim to determine the prevalence and factors associated with cervical discoligamentous injuries detected on magnetic resonance imaging (MRI) in acute, alert, neurologically intact trauma patients with computed tomography (CT) imaging negative for acute injury and persistent midline cervical spine tenderness. We present the cross-sectional analysis of baseline information collected as a component of a prospective observational study. Methods: Alert, neurologically intact trauma patients presenting to a Level I trauma center with CT negative for acute injury, who underwent MRI for investigation of persistent midline cervical tenderness, were prospectively recruited. Deidentified images were assessed, and injuries were identified and graded. Outcome measures included the presence and extent of MRI-detected injury of the cervical ligaments, intervertebral discs, spinal cord and associated soft tissues. Results: There were 178 patients recruited during a 2-year period to January 2009. Of these, 78 patients (44%) had acute cervical injury detected on MRI. There were 48 single-column injuries, 15 two-column injuries, and 5 three-column injuries. Of the remaining 10 patients, 6 had isolated posterior muscle edema, 2 had alar ligamentous edema, 1 had epidural hematoma, and 1 had atlanto-occipital edema. The injuries to 38 patients (21%) were managed clinically; 33 patients were treated in cervical collars for 2 to 12 weeks, and 5 patients (2.8%) underwent operative management, 1 of whom had delayed instability. Ordinal logistic regression revealed that factors associated with a higher number of spinal columns injured included advanced CT-detected cervical spondylosis (odds ratio [OR] 11.6; 95% confidence interval [CI] 3.9 to 34.3), minor isolated thoracolumbar fractures (OR 5.4; 95% CI 1.5 to 19.7), and multidirectional cervical spine forces (OR 2.5; 95% CI 1.2 to 5.2). Conclusion: In patients with cervical midline tenderness and negative acute CT findings, we found that a subset of patients had MRI-detected cervical discoligamentous injuries and that advanced cervical spine degeneration evident on CT, minor thoracolumbar fracture, and multidirectional cervical spine forces were associated with increased injury extent. However, a larger study is required to validate which variables may reliably predict clinically important injury in such patients, thereby indicating the need for further radiographic assessment. [Ann Emerg Med. 2011;58:521-530.] Please see page 522 for the Editor’s Capsule Summary of this article. Provide feedback on this article at the journal’s Web site, www.annemergmed.com. A podcast for this article is available at www.annemergmed.com. 0196-0644/$-see front matter Copyright © 2011 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2011.06.008 Volume , .  : December  Annals of Emergency Medicine 521