Soft tissue injury protocol (STIP) using motion MRI for cervical spine trauma assessment.

The purpose of this study was to establish a noninvasive scoring method, using motion MRI, to determine the degree of clinical impairment in traumatized cervical spines. This method is called the soft tissue injury protocol (STIP) scoring method. The cervical spines of 100 adult accident victims were evaluated prospectively using motion MRI at 12 weeks following hyperflexion/hyperextension injury from rear, low-impact motor vehicle collisions. Subjects were scored for degree of functional impairment based on an eight-point scale derived from the following clinical criteria: hypolordosis, motion restriction, disk herniation, and spinal stenosis. Five classes of impairment, ranging from normal to severe impairment, were identified as a basis for therapeutic management. Using the STIP scoring method, 94% of patients (94 of 100) were determined to have nonsurgical injuries. Class 1 and 2 injuries indicated mild impairment and were found in 68% of patients, who were considered to have reached maximum medical improvement at 12 weeks after injury. A Class 3 injury indicated moderate impairment and was found 26% of patients, who required an additional 12 weeks of rehabilitative and medical treatment to achieve maximum medical improvement. Class 4 and 5 injuries indicated severe impairment; these were identified in 6% of patients and required surgical intervention. Five of the six patients requiring surgery (83%) achieved maximum medical improvement at 36 weeks after injury. The STIP scoring method is a practical, noninvasive method of determining the degree of clinical impairment, as a basis for distinguishing injury requiring medical treatment from injury requiring surgical treatment, in cases of subacute cervical spine trauma.