Forecasting motor recovery after cervical spinal cord injury: value of MR imaging.

Abstract

An initial MR imaging evaluation of the spinal cord after spinal cord injury provides supplemental prognostic information on the recovery of motor function in the upper and lower extremities.

Traumatic cervical instability associated with cord oedema and temporary quadriparesis

“…4,10 Cord lesions with T1-weighted iso-to hypointense and T2-weighted hyperintense MRI images are suggestive of cord contusion and oedema. 5,7,10,13,14 At the present time, MRI resolution for differentiation of oedema with or without petechial haemorrhage is probably not yet reliable enough. Our patient most likely had no Figure 4 Lateral plain X-ray of the cervical spine 6 weeks postoperatively.…”

“…9,10,12,19 In recent years, the radiological assessment protocol for acute cervical spine trauma was challenged: increasingly the three standard radiological views are combined with MRI or helical CT of the complete cervical spine instead of conventional CT. [5][6][7] Especially in patients with neurological dysfunction, MRI probably is the first radiological modality to be applied. 4,5 Multiplane MRI not only depicts eventual neurocompression and discoligamentous injury, it may also show haematomyelia, cord transection and cord oedema. 4,10 Cord lesions with T1-weighted iso-to hypointense and T2-weighted hyperintense MRI images are suggestive of cord contusion and oedema.…”

“…2,12 Since MRI reliably depicts the location of the cord lesion, its rostral and caudal ends and the eventual presence of intra-axial haematomas, MRI, together with the clinical presentation, play an important role in the prognosis of the respective cord lesion. 4,5,[7][8][9]11,[13][14][15] Patients with a high intense cord lesion in T2-and a low intense lesion in T1-weighted MRI fare worse than patients with a lesion in T2-weighted images alone. 14,15 For focal cord oedema involving only one spinal segment or less, motor recovery can be expected in 72% of cases, in contrast to 42% in patients with oedema over more than one segment.…”

“…[1][2][3] However, in recent years this evaluation protocol was challenged by the introduction of magnetic resonance imaging (MRI) and helical CT of the complete cervical spine. 4 The latter diagnostic methods are increasingly used in the acute stage and especially in case of neurological dysfunction at first presentation or in case of negative results of initial plain films and conventional CT. [5][6][7] Moreover, plain films and CT, on which spinal cord injury without radiological abnormality (SCIWORA) diagnosis usually is based, may be insufficient and additionally miss soft-tissue lesions. 3,8,9 MRI depicts several types of intrinsic cord lesions as well as neurocompressive and discoligamentous injuries.…”

“…With increasing resolution, MRI is a very useful tool in evaluating prognosis of several of these lesions. 4,5,[7][8][9]11,[13][14][15] It is the aim of this report to present the assessment and the surgical treatment of a 73-year-old man who presented initially with a complete cord syndrome after blunt cervical spine trauma and to focus the attention on MRI appearance of cord oedema as well as discoligamentous lesions with subsequent spinal instability.…”