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Recognition of cervical spine (c-spine) injury is important to minimize the risk of disability. Yet the ideal method to detect injury remains controversial, especially in unexaminable patients. The purpose of this study was to evaluate the incidence of c-spine injury detected by magnetic resonance imaging (MRI) in patients with no abnormalities detected by computerized tomography (CT) scan and to determine whether the treatment plan was altered.A retrospective study was performed on all patients who underwent both CT and MRI scanning of the c-spine in 2004 to 2005. Unexaminable patients formed a separate subgroup of the overall cohort. Patients were deemed to be unexaminable by the attending surgeon if their mental status remained depressed after intoxicants were judged to have been metabolized. CT and MRI scan findings were defined as normal if they were without any radiographic abnormality and showed only chronic degenerative changes.A total of 254 adult patients were included. Of these, 53 patients were unexaminable. Ninety patients showed abnormality on CT scan and were excluded from further analysis. MRI detected an injury in 42 of the remaining 164 patients whose CT scan disclosed nothing abnormal, 27 of which were ligamentous or cord injuries. The findings of the MRI resulted in surgery in 9, maintenance of the rigid cervical collar in 22, and discontinuance of the collar in 11 patients. In the unexaminable cohort, MRI detected an injury in 5 of 46 patients whose CT scan disclosed nothing abnormal, four of which were ligamentous and were treated by cervical collar immobilization.This study supports the practice of obtaining c-spine MRI in patients who are either unexaminable or symptomatic with the CT scan findings normal.