From the Guidelines
MRI of the cervical spine is indicated for patients with suspected spinal cord or nerve root injury, persistent neck pain, neurological symptoms, or suspected spinal pathology that requires detailed soft tissue visualization. Common indications include:
- Suspected disc herniation
- Spinal cord compression
- Myelopathy
- Radiculopathy
- Trauma with neurological deficits
- Infection
- Tumor
- Inflammatory conditions affecting the cervical spine, as stated in 1. MRI is particularly valuable when symptoms persist despite conservative treatment for 4-6 weeks, when there are progressive neurological deficits, or when red flag symptoms such as fever, unexplained weight loss, or bowel/bladder dysfunction are present. It's preferred over CT scans for evaluating soft tissues, including intervertebral discs, spinal cord, nerve roots, and ligaments, as noted in 1 and 1. The procedure typically takes 30-45 minutes and may require contrast enhancement with gadolinium in cases of suspected infection, inflammation, or tumors to improve diagnostic accuracy. In cases of suspected acute blunt trauma of the cervical spine and confirmed or suspected cervical spinal cord or nerve root injury, MRI cervical spine without IV contrast is usually appropriate as the next imaging study, as stated in 1. However, MRI is contraindicated in patients with certain metallic implants, pacemakers, or severe claustrophobia, though open MRI options may be available for claustrophobic patients. Overall, the decision to perform an MRI of the cervical spine should be based on the clinical presentation and the need for detailed soft tissue visualization, as emphasized in 1.
From the Research
Indications for MRI of the Cervical Spine
The following are indications for an MRI of the cervical spine:
- Trauma to the cervical spine, especially in patients with neurologic symptoms or advanced cervical degenerative disease 2
- Acute spinal cord injury (SCI) to identify cord compression, disc herniation, ligamentous injury, and epidural hematoma 3
- Cervical spine fractures, particularly in patients with neurologic deficit, polytrauma, or spondylosis 4
- Soft tissue and ligamentous injuries in the cervical spine 5
- Prognostic value of extradural and intradural features detected on MRI performed acutely following traumatic cervical SCI, such as maximal spinal cord compression, length of cord edema, intramedullary hemorrhage, and length of intramedullary hemorrhage 6
Specific Patient Populations
MRI of the cervical spine may be particularly useful in the following patient populations:
- Older patients (>60 years) with cervical spine fractures 4
- Patients with polytrauma or spondylosis 4
- Patients with neurologic deficit or obtunded status 4
- Patients with advanced cervical degenerative disease 2
Clinical Decision-Making
MRI findings can alter clinical management in acute cervical spine injuries, including: