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  • Writer's pictureDr Josh Bonine DC

Spinal Injuries – MRI Is not enough

Spinal Injuries – MRI Is not enough

The rationale for combined imaging modalities to objectify bodily injury


Understanding how to use different imaging modalities such as MRI and plain film x-rays is a critical component in caring for the traumatically injured. Each modality is sensitive for imaging certain tissues, but they also have limitations.

The key to reducing these limitations is to combine imaging types with comprehensive histories and physical examinations.

This concept is further outlined in a recent study by Haris et al. (2016), where the authors stated that the purpose of the study was, “To compare and correlate soft tissue injuries detected on MRI in cases of spinal trauma to the intraoperative evidence found by the surgeon” (p. TC01). Basically, what they were looking at was what was shown on MRI studies and comparing those findings to what surgeons actually found while they were operating on the patients. This gives us some idea of the limitations of MRI and suggests a need for other means we might use in addition to MRI in order to more accurately evaluate the trauma patient.

“Injuries to the soft tissues of the spine were evaluated as described earlier from anterior to posterior is as follows; Anterior Longitudinal Ligament, Intervertebral Disc, Posterior Longitudinal Ligament, Spinal Cord including the conus medullaris, Ligamentum Flavum and Interspinous Ligament” (Haris et al., 2016, p. TC03). The article continues, “MRI was found to be highly sensitive in detecting injuries to the spinal cord and the posterior longitudinal ligament and moderately sensitive for detection of disc injuries. On the other hand, where the anterior longitudinal ligament, ligamentum flavum and the interspinous ligament are concerned, MRI performed ineffectively with higher number of false negative interpretations” (Haris et al., 2016, p. TC04). This is precisely why stress views (flexion and extension) are important when evaluating spinal injuries.

Finally, the authors report, “Hence to conclude, the utilization of MRI in assessing non-osseous injuries to the spine is well established and should be the modality of choice in evaluating spinal injuries, even when using low field strength magnets” (Haris et al., 2016, p. TC04). However, what we see as a result of this paper is that for certain structures in the spine, a combined imaging approach is necessary. Integrating flexion and extension radiographs with the MRI studies is an essential component of care for spinal injured patients.


Haris, A. M., Vasu, C., Kanthila, M., Ravichandra, G., Acharya, K. D., & Hussain, M. M. (2016). Assessment of MRI as a modality for evaluation of soft tissue injuries of the spine as compared to intraoperative assessment. Journal of Clinical and Diagnostic Research, 10(3), TC01-TC05.


Spine & Injury Centers of San Antonio is a local network of 5 chiropractic offices. As a group, we are raising the standard of care for injured patients and their families.

If you have recently been in a car accident, or had a personal injury, sports injury, or exercise injury, and are experiencing back pain, neck pain, knee pain, whiplash, headaches, leg pain, etc, our San Antonio injury chiropractors can help!

Our goal is to get you back to living a pain-free life as quickly as possible.

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