Neurologic Recovery According to Early Magnetic Resonance Imaging Findings in Traumatic Cervical Spinal Cord Injuries

Abstract

The aim of this study was to determine the usefulness of early magnetic resonance imaging findings in predicting neurologic recovery at or below the injured level in traumatic cervical spinal cord injuries. Thirty patients with traumatic cervical spinal cord injuries were included. All of the patients received a magnetic resonance imaging and a neurologic examination in the emergency room, within 7 days of injury and at 6 months following the injury. To quantify neurologic recovery below the injured level, we modified clinical scales, particularly the motor ratio and the sensory ratio. We used the neurologic level to quantify recovery around the injured level. We assessed neurologic recovery according to MRI patterns and lesion extents. The pure hemorrhagic MRI pattern was not observed. In edematous and mixed types, the improvement of neurologic levels was not significantly different. The motor ratio and sensory ratio improved significantly more in edematous type patients than in mixed type patients. Based on MRI lesion extent, the improvement of neurologic levels was not significantly different, and motor ratio and sensory ratio improved significantly more in those with one or two segments involved than in those with more than two segments involved. In conclusion, early MRI pattern and lesion extent after traumatic cervical spinal cord injury may provide important information to help predict neurologic recovery, especially below the injured level.

Magnetic resonance imaging of spinal trauma at acute and early stage

“…Метод позво-ляет визуализировать протяженность и выраженность повреждения спинного мозга, что обусловливает важ-ность метода на начальном этапе лечения пациентов с позвоночно-спинномозговой травмой [3].…”

“…Это обусловливает важность метода на началь-ном этапе лечения пациентов с позвоночно-спинно-мозговой травмой [1][2][3].…”

Imaging of Acute Spinal Cord Trauma and Spinal Cord Injury

“…Increased signal in T2-weighted images alone, representing spinal cord edema, is thought to predict neurological recovery, 12-14 whereas patients with mixed changes in both T1and T2-weighted images tend not to recover neurological function. 13 Patients with parenchymatous hemorrhage and contusion demonstrate little or no neurological recovery. 12, 14,15 The rostrocaudal length of signal change was associated with the degree of recovery.…”

“…12, 14,15 The rostrocaudal length of signal change was associated with the degree of recovery. For example, Shin et al 13 report that if the signal change is two vertebral segments or less (compared with greater than two segments), the patient is more likely to recover. Similarly, Boldin et eter at the normal levels immediately above and below the level of injury.…”

Neuroimaging in Traumatic Spinal Cord Injury: An Evidence-based Review for Clinical Practice and Research

“…2. Use of MRI findings for prognostic purposes: As an extension of the investigation of MRI and severity of injury correlates, 6 Class II studies(14,15,(26)(27)(28)(29),13 Class III studies(16,17,19,(21)(22)(23)(24)(30)(31)(32)(33)(34)(35), 6 Class IV studies(5,25,(36)(37)(38)(39), one Class III clinical animal study(40), and 4 preclinical studies(7,8,10,11) have shown a relationship between acute SCI MRI signal abnormality and neurological outcome over timethe use of early MRI findings as a prognostic indicator for recovery of function. Parenchymal hemorrhage (7,9,11,14,16,17,19-25,27,28,30,31, 33,34,36,40), transection (19,22), and longer lesion length (8,16,20,25,28,30,41) were correlated with less favorable neurological outcome.…”