Multidetector CT of blunt cervical spine trauma in adults.

A number of new developments in cervical spine imaging have transpired since the introduction of 64-section computed tomographic (CT) scanners in 2004. An increasing body of evidence favors the use of multidetector CT as a stand-alone screening test for excluding cervical injuries in polytrauma patients with obtundation. A new grading scale that is based on CT and magnetic resonance (MR) imaging findings, the cervical spine Subaxial Injury Classification and Scoring (SLIC) system, is gaining acceptance among spine surgeons. Radiographic measurements described for the evaluation of craniocervical distraction injuries are now being reevaluated with the use of multidetector CT. Although most patients with blunt trauma are now treated nonsurgically, evolution in the understanding of spinal stability, as well as the development of new surgical techniques and hardware, has driven management strategies that are increasingly favorable toward surgical intervention. It is therefore essential that radiologists recognize findings that distinguish injuries with ligamentous instability or a high likelihood of nonfusion that require surgical stabilization from those that are classically stable and can be treated with a collar or halo vest alone. The purpose of this article is to review the spectrum of cervical spine injuries, from the craniocervical junction through the subaxial spine, and present the most widely used grading systems for each injury type.

Evidence for altered spinal canal compliance and cerebral venous drainage in untreated idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a debilitating neurological disorder characterized by elevated CSF pressure of unknown cause. IIH manifests as severe headaches, and visual impairments. Most typically, IIH prevails in overweight females of childbearing age and its incidence is rising in parallel with the obesity epidemic. The most accepted theory for the cause of IIH is reduced absorption of CSF due to elevated intracranial venous pressure. A comprehensive MRI study, which includes structural and physiological imaging, was applied to characterize morphological and physiological differences between a homogeneous cohort of female IIH patients and an age- and BMI-similar control group to further elucidate the underlying pathophysiology. A novel analysis of MRI measurements of blood and CSF flow to and from the cranial and spinal canal compartments employing lumped parameters modeling of the cranio-spinal biomechanics provided, for the first time, evidence for the involvement of the spinal canal compartment. The CSF space in the spinal canal is less confined by bony structures compared with the cranial CSF, thereby providing most of the craniospinal compliance. This study demonstrates that the contribution of spinal canal compliance in IIH is significantly reduced.