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Usefulness of MRI in isolated upper cervical spine fractures in adults.

A prospective analysis of patients admitted with isolated upper cervical spine fractures and who had magnetic resonance (MR) imaging performed within 48 h of the inciting traumatic event was completed to determine the clinical usefulness and cost effectiveness of routine MR screening. In patients with an identified neurologic deficit, MR findings changed the treatment of 25% (one of four) of the patients, whereas MR findings did not change the treatment of any patient identified without a neurologic deficit. We recommend that in adult patients with an isolated upper cervical spine fracture, MR should not be routinely ordered in patients without a neurologic deficit. This advanced imaging modality is not a useful or cost-effective screening device for patients presenting with a fracture of the upper cervical spine without neurologic deficit.