Evaluation of spinal trauma: CT versus MRI in detecting ligamentous and cord injury—an observational cross-sectional study.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i2.2682Keywords:
Spinal trauma, Dual-energy computed tomography, magnetic resonance imaging, Ligamentous injury, Spinal cord injury, Diagnostic accuracyAbstract
Background:
Spinal trauma is a major cause of morbidity and disability, requiring prompt and accurate diagnosis. While Computed Tomography (CT) is widely used for initial assessment, its limitations in detecting soft tissue injuries necessitate the evaluation of Magnetic Resonance Imaging (MRI) as a complementary modality. The study compares the effectiveness of CT and MRI in detecting ligamentous and spinal cord injuries in patients with spinal trauma.
Methods:
This prospective observational study was conducted over 18 months in a tertiary care hospital and included 120 patients with suspected spinal trauma. All patients underwent CT followed by MRI within 48 hours. CT was evaluated for fractures and indirect signs of ligamentous injury, while MRI assessed ligamentous and spinal cord abnormalities. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and correlation with neurological deficits was analyzed.
Results:
Most patients were aged 31–50 years (45%), and road traffic accidents were the commonest cause of injury (56.7%). CT and MRI showed comparable fracture detection (102 vs 104 cases). However, MRI detected significantly more ligamentous injuries (86 vs 38) and spinal cord injuries (78 vs 22). MRI demonstrated higher sensitivity (94% vs 62%), specificity (91% vs 88%), PPV (93% vs 80%), and NPV (92% vs 72%) than CT. MRI findings correlated strongly with neurological deficits, identifying abnormalities in 70 patients compared with 28 detected by CT.
Conclusion:
MRI is superior to CT in detecting ligamentous and spinal cord injuries, while CT remains highly effective for fracture assessment. A combined CT–MRI approach provides the most accurate evaluation of spinal trauma and supports optimal clinical management.
Recommendations:
CT should be the initial imaging modality in acute spinal trauma, while MRI should be performed in patients with neurological deficits, suspected ligamentous injury, or inconclusive CT findings to improve diagnostic accuracy and guide treatment decisions.
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