Effect of Magnetic Resonance Imaging on Surgical Approach and Outcomes in the Management of Subaxial Cervical Fractures

BACKGROUND: In the initial evaluation of suspected cervical fracture, computed tomography (CT) is the gold standard for assessing bony anatomy and fracture morphology with high sensitivity and specificity. However, CT is relatively insensitive to ligamentous, discogenic, and myelopathic injury, leading to supplementary use of MRI, which is more sensitive and specific to these diseases. Here, we assess whether preoperative cervical spine magnetic resonance imaging (MRI) affects surgical management of subaxial cervical fractures. METHODS: The National (Nationwide) Inpatient Sample (NIS) was queried for MRI use, surgical approach, rate of operative intervention, all-cause mortality, days from admission to surgery, discharge disposition, length of hospital stay, and total hospital charges among those with closed subaxial cervical spine fractures from 2012 to 2015. The effect of MRI on these End points was evaluated, controlling for significant baseline differences in demographics, comorbidities, and presentation. RESULTS: A total of 820 patients met inclusion and exclusion criteria; 255 (31.1%) were assessed with MRI and CT, 565 (68.9%) were evaluated with CT alone. After 1:1 propensity score matching based on severity of presentation, preoperative MRI was not significantly associated with surgical approach, in-hospital mortality, discharge disposition, length of stay, or total hospital charges. Segregating patients by functional status group shows MRI use among patients presenting with moderate loss of function associated with a shorter length of time between admission and surgery (1.50 vs. 2.59 days; P = 0.027). CONCLUSIONS: The addition of MRI to CT in the evaluation of subaxial cervical spine fractures does not seem to affect surgical management.