The Adult Spinal Cord Injury Without Radiographic Abnormalities Syndrome: Magnetic Resonance Imaging and Clinical Findings in Adults With Spinal Cord Injuries Having Normal Radiographs and Computed Tomography Studies

Kasimatis, Georgios; Panagiotopoulos, Elias; Megas, Panagiotis; Matzaroglou, Charalampos; Gliatis, John; Tyllianakis, Minos; Lambiris, E.

doi:10.1097/ta.0b013e318157495a

Cited by 69 publications

(56 citation statements)

References 20 publications

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“…Unlike the children's spines, the flexibility of adult spine is reduced with increasing age, and the likelihood of spinal injury becomes greater. Interestingly, SCIWORA is commonly seen among middle-aged and geriatric populations [8].…”

Section: Introductionmentioning

confidence: 99%

“…Most of the adult patients with SCIWORA may reveal abnormalities on radiographic findings, including degenerative stenosis, ossification of the posterior longitudinal ligament (OPLL), modic changes, etc. [8]. Many factors, ranging from injury origin, injury level or severity, and MRI features allow for the assessment of the epidemiology of SCIWORA.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study

Guo

Liu

et al. 2011

Eur Spine J

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Introduction The epidemiology of spinal cord injury without radiographic abnormality (SCIWORA) is less frequently reported in adults as compared with children. ResultsIn total, 203 patients were enrolled. The average age among the adult groups was 55.9 years (men 55.8 years, women 53.6 years). SCIWORA occurred more commonly in adults in the 46-60 age group, and falls were the leading cause of injury (52.2%), followed by vehicular injury (28.6%). The most predominantly affected level was C4/5 (48.7%), followed by C5/6 (30.5%) and C3/4 (12.8%), respectively. The occurrence of central cord syndrome (50.2%) with posterior longitudinal ligament tear (43.8%) was relatively higher than other injury patterns. Conclusion It is clear that adult cervical SCIWORA is different from that in the pediatric group. Our study highlights the epidemiological properties of adult SCIW-ORA in Tianjin, China. Differing from other reports, particularly epidemiology study, we represent the first report regarding adult SCIWORA from China. As the geriatric population increases, it is very important to set up an individualized evaluation system based on a nationally scaled epidemiological database. The results from our study will be useful in assisting in the creation of such a database.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study

Guo

Liu

et al. 2011

Eur Spine J

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“…However, the term 'spinal cord injury without radiologic evidence of trauma (SCIWORET)' was recommended to be used for the adult population, to include the situation that plain radiographs and computed tomography scan do not show any evidence of trauma except for pre-existing cervical spondylosis. [3][4][5] Surgical intervention is recommended by many authors under the circumstances of cervical cord compression on magnetic resonance imaging (MRI) responsible for neurological deficits in older patients with SCIWORET as reported outcomes with conservative management may have profound residual deficits, particularly in the hands, [6][7][8] and minor trauma may induce symptomatic spinal cord compression unexpectedly due to a pre-existing pathology, despite the patient being asymptomatic before the trauma. How to predict neurological outcomes after surgery is of great importance for the management of the patients with SCIWORET.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 To date, post-operative MRI has not yet been fully studied in relation to the correlation of morphology or signal change of cervical cord and longer term prognosis in patients with SCIWORET. 5,[12][13][14] In our study, we have focused on quantitative analysis of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted MRI pre-and postoperatively. The purpose of the present study was to investigate whether range of signal intensity (RSI), grayscale of signal intensity (GSI), TA of the spinal cord and prevertebral hyperintensities (PVHs) reflect the surgical outcome in patients with SCIWORET.…”

Section: Introductionmentioning

confidence: 99%

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spinal cord injury without radiologic evidence of trauma

Shen

2014

Spinal Cord

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Study design: Prospective study. Objectives: To investigate whether pre-and post-operative changes of signal intensity (SI) and transverse area (TA) of the spinal cord on T2-weighted magnetic resonance imaging (MRI) reflect the surgical outcome in patients with spinal cord injury (SCI) without radiologic evidence of trauma (SCIWORET). Setting: The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. Methods: In 36 consecutive prospective patients, MRI was performed pre-operatively and 3 months post-operatively. The Japanese Orthopaedic Association (JOA) scale and the American Spinal Cord Injury Association (ASIA) motor score (AMS) were used to quantify neurologic status at admission and at least 12-month follow-up. Pre-and post-operative TA, range of signal intensity (RSI), grayscale of signal intensity (GSI) and prevertebral hyperintensities (PVHs) were measured using the image analysis software. Pre-operative status and post-operative recovery were assessed in relation to MRI parameters pre-and post-operatively using univariate and multivariate analysis. Results: Pre-operative JOA and AMS score negatively correlates RSI, GSI and PVH. There was no significant correlation between pre-operative TA and pre-operative JOA and AMS. Recovery rate with JOA negatively correlates pre-operative RSI, post-operative RSI, pre-operative GSI, post-operative GSI and PVH. There was a significant negative correlation between recovery rate with AMS and pre-operative RSI, post-operative GSI and PVH. From these results of multivariate stepwise regression analysis, the predictors of surgical outcomes are pre-operative GSI and pre-operative RSI. Conclusion: Quantitative MRI analysis may provide reliable information for the prediction of the initial neurological status and surgical outcome of patients with SCIWORET.

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“…5 To our knowledge, there have been only few reports on the MRI features of patients with CSCI without major bone injury. 6,7 The most common acute MRI pattern described is no change of signal intensity on T1-weighted images with a blurred high-intensity area on T2-weighted images. In the subacute and chronic stages, a low-intensity area begins to appear on T1-weighted images.…”

Section: Introductionmentioning

confidence: 99%

Subacute T1-low intensity area reflects neurological prognosis for patients with cervical spinal cord injury without major bone injury

et al. 2015

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Study design: A retrospective imaging and clinical study. Objectives: To evaluate the relationship between magnetic resonance imaging (MRI) features and neurological prognosis in patients with traumatic cervical spinal cord injury (CSCI) without major bone injury. Methods: A total of 72 patients with CSCI without major bone injury were treated conservatively in our hospital. MRI was performed for all patients at admission and 1 month following injury. We measured the antero-posterior and cranio-caudal diameter of intramedullary intensity changed area with T1-weighted images at the injured segment. Neurological evaluations were performed using the American Spinal Injury Association (ASIA) motor score and the modified Frankel grade at the time of admission and discharge.Results: There was a significant relationship between the antero-posterior diameter ratio of the T1-weighted low-intensity area on MRI at the subacute stage and the ASIA motor score. The optimal threshold of the T1-weighted low-intensity diameter ratio for predicting the patient's ability to walk with or without assistance at discharge was determined to be 46%. Moreover, 96.8% of the patients with o50% T1-weighted low-intensity area recovered to walk with or without a cane at discharge. Conclusion: The T1-low intensity area may be an important predictive factor for the neurological recovery of CSCI without major bone injury.

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The Adult Spinal Cord Injury Without Radiographic Abnormalities Syndrome: Magnetic Resonance Imaging and Clinical Findings in Adults With Spinal Cord Injuries Having Normal Radiographs and Computed Tomography Studies

Cited by 69 publications

References 20 publications

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study

Quantitative magnetic resonance imaging analysis correlates with surgical outcome of cervical spinal cord injury without radiologic evidence of trauma

Subacute T1-low intensity area reflects neurological prognosis for patients with cervical spinal cord injury without major bone injury

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