The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

Abstract

The clinical indications and added value of obtaining MRI in the acute phase of spinal cord injury (SCI) remain controversial. This review aims to critically evaluate evidence regarding the role of MRI to influence decision-making and outcomes in acute SCI. A systematic review and meta-analysis were performed according to PRISMA methodology to identify studies that address six key questions (KQs) regarding diagnostic accuracy, frequency of abnormal findings, frequency of altered decision-making, optimal timing, and differences in outcomes related to obtaining an MRI in acute SCI. A total of 32 studies were identified that addressed one or more KQs. MRI showed no adverse events in 156 patients (five studies) and frequently identified cord compression (70%, 12 studies), disc herniation (43%, 16 studies), ligamentous injury (39%, 13 studies), and epidural hematoma (10%, two studies), with good diagnostic accuracy (seven comparative studies) except for fracture detection. MRI findings often altered management, including timing of surgery (78%, three studies), decision to operate (36%, 15 studies), and surgical approach (29%, nine studies). MRI may also be useful to determine the need for instrumentation (100%, one study), which levels to decompress (100%, one study), and if reoperation is needed (34%, two studies). The available literature consistently concluded that MRI was useful prior to surgical treatment (13 studies) and after surgery to assess decompression (two studies), but utility before/after closed reduction of cervical dislocations was unclear (three studies). One study showed improved outcomes with an MRI-based protocol but had a high risk of bias. Heterogeneity was high for most findings (I2 > 0.75). MRI is safe and frequently identifies findings alter clinical management in acute SCI, although direct evidence of its impact on outcomes is lacking. MRI should be performed before and after surgery, when feasible, to facilitate improved clinical decision-making. However, further research is needed to determine its optimal timing, effect on outcomes, cost-effectiveness, and utility before and after closed reduction.

Prognostic MRI parameters in acute traumatic cervical spinal cord injury

“…Recently, some parameters on conventional MRI study have been described such as intramedullary lesion length (IMLL) and maximal spinal canal compression (MSCC). The author's hypothesis is that these parameters could be used for prognostic purpose in addition to the preoperative ASIA score evaluation [13]. In parallel, the scientific community is increasingly turning its attention to more sophisticated imaging techniques for studying spinal cord injury and its clinical implications.…”

A Case Report of Prolonged Bradycardia in Clay Shoveler’s Fracture: Presentation and Narrative Review

“…Several mechanisms have been proposed to cause spinal cord injury including 1) hyperflexion causing spinal traction, 2) hyperextension causing extrinsic cord damage, and 3) edema or vascular injury causing parenchymal cord damage (Bonfanti et al, 2019;Ghaffari-Rafi et al, 2021;Mohanty et al, 2013) The severity of spinal cord injury (SCI) can range from transient to permanent injury. The least severe injury is known as neuropraxia, which is as a transient loss of motor or sensory function that last from 15 minutes to 48 hours (Jin et al, 2021).…”

“…Cases with complete spinal cord injury rarely improve. Those with incomplete type ofen improve but seldom regain normal function (Konovalov et al, 2020)((Ghaffari-Rafi et al, 2021)Bonfanti et al, 2019 (Martineau et al, 2019).…”

“…Prolonged bradycardia is a rare complication of neurogenic shock. Its pathophysiology is still far from obvious (Boese & Lechler, 2013;Ghaffari-Rafi et al, 2021), moreover the consensus of its management (Shaikh et al, 2016;Wecht et al, 2020) This rare case report will present a spinal cord injury with prolonged bradycardia in a simple case of clay shoveler's fracture which the fracture line lies far from spinolaminar line, had a normal MRI and managed by implantation of cardiac pacemaker. The aim is to share awareness to other physician regarding of vertebral trauma complications and management should they face them in the field.…”

Degenerative Cervical Myelopathy and Spinal Cord Injury: Introduction to the Special Issue

“…This Special Issue also includes three systematic reviews. The first of these, by Ghaffari-Rafi et al [ 14 ], assessed the role and impact of obtaining an MRI in acute SCI on clinical outcomes and decision making. Of the 32 studies included, MR imaging frequently identified pathologies such as spinal cord compression, ligamentous injury, and epidural hematoma that altered the acute management of SCI, including the need for surgery, timing of surgery, and the surgical approach (anterior vs. posterior).…”