new gp mri indications…what does it all mean (part 2)

As of 1 November 2013, the GP MRI requesting rights have been extended to include indications for patients aged 16 years and over. These indications include Brain, Cervical spine and Knee.

This 3 part series will include case studies to help identify and highlight some appropriate senarios that MRI would be most useful. For more information please call our Randwick or Liverpool sites on 9399 5357 or 9600 9552.

part 2 – MRI Cervical spine

GPs can refer for a Medicare funded MRI cervical spine for trauma or radiculopathy.

cervical spine trauma

Case History 1

A 30 year old male dives into a shallow pool and is evaluated in the emergency department.

The head and neck were completely immobilised. The neurological examination was abnormal and cervical spine CT demonstrated a cervical fracture with dislocation of C6/7.

Case History 2

A 24 year old male driver was rear ended outside the GP practice.

He walks into the practice, sits down and asks for an evaluation. He complains of some delayed onset neck pain. He is alert on examination, without midline cervical tenderness and no other serious or painful injuries. There is no evidence of focal neurological deficits, with full range of neck motion and no signs of intoxication. He wants to know if he needs to get some imaging for his neck.

Discussion

The major concern of cervical spine trauma is cervical fracture which may be difficult to distinguish clinically. CT scan remains the recommended imaging of choice if cervical spine fracture is suspected, particularly in an acute emergency presentation. In the acute trauma setting, due to the devastating consequences of missed cervical fracture, immobilisation of the head and neck is key.

In primary care, tools such as the NEXUS criteria can be used to determine the need for neuroimaging 1. MRI is not indicated for fracture detection but is indicated if there is a contraindication to other imaging or there is indication of ligamentous, spinal cord or arterial injury. There is poor evidence that MRI is useful in whiplash injury evaluation as it is not useful for prognostic value or treatment guidance 2. Clinical judgement should be used to evaluate the need for MRI, since there is little evidence to show increased benefit of obtaining MRI in addition to CT cervical spine.

1 Clinical Guidance for MRI referral. East Melbourne: Royal Australian College of General Practitioners, 2013.

2 Kongsted, A., et al., Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up. European Spine Journal, 2008. 17(8): p. 996-1005.