Prognostic significance of magnetic resonance imaging in the acute phase of cervical spine injury

Abstract

Fifty-seven patients with acute cervical spine injuries and associated major neurological deficit were examined within 2 weeks of injury by magnetic resonance (MR) imaging. All patients had abnormal scans, indicating intramedullary lesions. This study was undertaken to determine if the early MR imaging pattern had a prognostic relationship to the eventual neurological outcome. Three different MR imaging patterns were observed in these patients: 21 patients had patterns characteristic of intramedullary hematoma (Group 1); 17 had intramedullary edema over more than one spinal segment, but no hemorrhage (Group 2); and 19 had restricted zones of intramedullary edema involving one spinal segment or less (Group 3). The neurological state was determined using standard motor index scores at admission and at follow-up examination. Characteristically, the patients in Group 1 had admission motor scores significantly lower than the other two groups. At follow-up examination, the median percent motor recovery was 9% for Group 1, 41% for Group 2, and 72% for Group 3. These studies suggest that the MR imaging pattern observed in the acutely injured human spinal cord has a prognostic significance in the final outcome of the motor system. It is only when an accurate prognosis can be given at the outset that useful treatment data might be collected for homogeneous injury groups, and accurately based long-term planning made for the best patient care.

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.…”

“…19 In the adult, SCIWORET is encountered more frequently than SCIWORA syndrome, even though both conditions are rare. 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.…”

“…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.…”