Magnetic Resonant Imaging Features of Acute Traumatic Cervical Spinal Cord Injury
Its Correlation with American Spinal Injury Association Impairment Scale and Prediction of Neurological Improvement using a Low Tesla Magnetic Resonant Imaging in a Resource‑Constrained Environment
Keywords:
American Spinal Injury Association, cervical spinal cord, injury, magnetic resonant imaging, neurological improvement, traumaAbstract
Context: Traumatic spinal cord injury (TSCI) is a devastating disease, hence the need to identify clinical and radiological injury features that can predict neurological improvement. Aims: This study aims to identify magnetic resonant imaging (MRI) features in cervical TSCI that correlates with neurological status at admission, and also predict early neurological improvement. Settings and Design: This was a prospective cohort study. Subjects and Methods: Admission MRI features of 47 patients with cervical TSCI and their neurological assessments at admission and 3 months post‑injury were reviewed prospectively over a period of 18 months. Correlational and regression analyses were done using SPSS® version 25 software. P < 0.05 was used as the level of significance. Results: Spinal cord oedema and cord contusion (78.0%) constitute the majority of injury patterns seen on MRI. There was a significant association between spinal cord contusion and cord oedema on MRI and incomplete TSCI. Likewise, spinal cord haemorrhage, compression and transection were associated with complete TSCI. Maximum canal compromise (MCC), maximum spinal cord compression (MSCC) and length of cord lesion significantly correlate with American Spinal Injury Association Impairment Scale at admission (P = 0.033, P = 0.015 and P < 0.001, respectively). Increasing values of these variables were found to be independent predictors of complete TSCI. However, length of cord lesion was the only independent predictor of neurological improvement, 3 months post‑injury (P = 0.025). Conclusions: Spinal cord haemorrhage, compression, transection and higher values of MCC, MSCC and increased length of cord lesion were predictive of complete TSCI. However, the length of spinal cord lesion was a better predictor of early neurological improvement.
References
1. Badhiwala JH, Wilson JR, Fehlings MG. Global burden of traumaticbrain and spinal cord injury. Lancet Neurol 2019;18:24‑5.
2. Lifshutz J, Colohan A. A brief history of therapy for traumatic spinalcord injury. Neurosurg Focus 2004;16:1‑8.
3. Ihegihu CC, Ugezu AI, Ndukwu CU, Chukwuka NC, Ofiaeli RO,Ihegihu EY. A review of traumatic spinal cord injuries at NnamdiAzikiwe University Teaching Hospital. Trop J Med Res 2014;17:31‑6.
4. Bedbrook GM. The development and care of spinal cord paralysis (1918to 1986) Paraplegia 1987;25:172‑84.
5. Guttmann L. Spinal Cord Injuries: Comprehensive Management andResearch. 2nd ed. Oxford, UK: Blackwell Scientific; 1976. p. 1‑76.
6. GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury andspinal cord injury, 1990‑2016: A systematic analysis for the GlobalBurden of Disease Study 2016. Lancet Neurol 2019;18:56‑87.
7. Nobunaga AI, Go BK, Karunas RB. Recent demographic and injurytrends in people served by the Model Spinal Cord Injury Care Systems. Arch Phys Med Rehabil 1999;80:1372‑82.
8. Haar M, Naidoo SM, Govender S, Parag P, Esterhuizen TM. Acutetraumatic cervical spinal cord injuries: Correlating MRI findings withneurological outcome. SA Orthop J 2011;10:35‑41.
9. Ditunno JF Jr. The John Stanley Coulter Lecture. Predicting recoveryafter spinal cord injury: A rehabilitation imperative. Arch Phys MedRehabil 1999;80:361‑4.
10. La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F. Does earlydecompression improve neurological outcome of spinal cord injuredpatients? Appraisal of the literature using a meta‑analytical approach.Spinal Cord 2004;42:503‑12.
11. Burns AS, Ditunno JF. Establishing prognosis and maximizingfunctional outcomes after spinal cord injury: A review of current andfuture directions in rehabilitation management. Spine (Phila Pa 1976)2001;26:S137‑45.
12. van Middendorp JJ, Goss B, Urquhart S, Atresh S, Williams RP,Schuetz M. Diagnosis and prognosis of traumatic spinal cord injury.Global Spine J 2011;1:1‑8.
13. Bondurant FJ, Cotler HB, Kulkarni MV, McArdle CB, Harris JH Jr. Acute spinal cord injury. A study using physical examination andmagnetic resonance imaging. Spine (Phila Pa 1976) 1990;15:161‑8.
14. Singh R, Kumar RR, Setia N, Magu S. A prospective study ofneurological outcome in relation to findings of imaging modalities inacute spinal cord injury. Asian J Neurosurg 2015;10:181‑9.
15. Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF,Northrup BE. Acute cervical spine trauma: Correlation of MR imagingfindings with degree of neurologic deficit. Radiology 1990;177:25‑33.
16. Magu S, Singh D, Yadav RK, Bala M. Evaluation of traumatic spine bymagnetic resonance imaging and correlation with neurological recovery. Asian Spine J 2015;9:748‑56.
17. Miyanji F, Furlan JC, Aarabi B, Arnold PM, Fehlings MG. Acutecervical traumatic spinal cord injury: MR imaging findings correlatedwith neurologic outcome – Prospective study with 100 consecutivepatients. Radiology 2007;243:820‑7.
18. Kulkarni MV, Bondurant FJ, Rose SL, Narayana PA. 1.5 teslamagnetic resonance imaging of acute spinal trauma. Radiographics1988;8:1059‑82.
19. Ramón S, Domínguez R, Ramírez L, Paraira M, Olona M, Castelló T, et al. Clinical and magnetic resonance imaging correlation in acutespinal cord injury. Spinal Cord 1997;35:664‑73.
20. Rao KV, Vijaya Saradhi M, Purohit AK. Factors affecting long‑termoutcome in acute cervical cord injury. Indian J Neurotrauma2010;7:149‑55.
21. Gupta R, Mittal P, Sandhu P, Saggar K, Gupta K. Correlation ofqualitative and quantitative MRI parameters with neurological status:A prospective study on patients with spinal trauma. J Clin Diagn Res2014;8:RC13‑7.
22. Ochie K, Okpala OC, Ohagwu CC, Eze CU. Profile of MRIfindings and neurological impairment in spinal cord injury patientsat Lagos University Teaching Hospital, Nigeria. World J Med Sci2013;8:418‑23.
23. Parashari UC, Khanduri S, Bhadury S, Kohli N, Parihar A, Singh R,et al. Diagnostic and prognostic role of MRI in spinal trauma, itscomparison and correlation with clinical profile and neurologicaloutcome, according to ASIA impairment scale. J Craniovertebr JunctionSpine 2011;2:17‑26.
24. Mahmood NS, Kadavigere R, Avinash KR, Rao VR. Magneticresonance imaging in acute cervical spinal cord injury: A correlativestudy on spinal cord changes and 1 month motor recovery. Spinal Cord2008;46:791‑7.
25. Kulkarni MV, McArdle CB, Kopanicky D, Miner M, Cotler HB,Lee KF, et al. Acute spinal cord injury: MR imaging at 1.5 T. Radiology1987;164:837‑43.
26. Rao SC, Fehlings MG. The optimal radiologic method for assessingspinal canal compromise and cord compression in patients with cervicalspinal cord injury. Part I: An evidence‑based analysis of the publishedliterature. Spine (Phila Pa 1976) 1999;24:598‑604.
27. Fehlings MG, Rao SC, Tator CH, Skaf G, Arnold P, Benzel E, et al. Theoptimal radiologic method for assessing spinal canal compromise andcord compression in patients with cervical spinal cord injury. Part II:Results of a multicenter study. Spine 1999;24:605‑13.
28. Fehlings MG, Furlan JC, Massicotte EM, Arnold P, Aarabi B,Harrop J, et al. Interobserver and intraobserver reliability of maximumcanal compromise and spinal cord compression for evaluation ofacute traumatic cervical spinal cord injury. Spine (Phila Pa 1976)2006;31:1719‑25.
29. Kartz LD, Elmore JG, Wild DM, Lucan SC. Applying statistics to trialdesign: Sample size randomization and control for multiple hypotheses. In: Kartz LD, Elmore JG, Wild DM, Lucan SC, editors. JekelsEpidemiology, Biostatistics, Preventive Medicine and Public Health. 4thed.. Philadelphia: Elsevier Saunders; 2014. p. 153‑62.
30. Martínez‑Pérez R, Paredes I, Cepeda S, Ramos A, Castaño‑León AM,García‑Fuentes C, et al. Spinal cord injury after blunt cervical spinetrauma: Correlation of soft‑tissue damage and extension of lesion. AJNR Am J Neuroradiol 2014;35:1029‑34.
31. Talbott JF, Whetstone WD, Readdy WJ, Ferguson AR, Bresnahan JC,Saigal R, et al. The Brain and Spinal Injury Center score: A novel,simple, and reproducible method for assessing the severity of acutecervical spinal cord injury with axial T2‑weighted MRI findings. J Neurosurg Spine 2015;23:495‑504.
32. Fehlings MG, Tator CH. An evidence‑based review of decompressivesurgeryin acute spinal cord injury: Rationale, indications, and timingbased on experimental and clinical studies. J Neurosurg (Spine 1)1999;91:1‑11.
33. Fehlings MG, Vaccaro A, Wilson JR, Singh A, Cadotte DW, Harrop JS,et al. Early versus delayed decompression for traumatic cervical spinalcord injury: Results of the Surgical Timing in Acute Spinal Cord InjuryStudy (STASCIS). PLoS One 2012;7:E32037.
34. Shimada K, Tokioka T. Sequential MR studies of cervical cord injury:Correlation with neurological damage and clinical outcome. SpinalCord 1999;37:410‑5.
35. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. The roleof magnetic resonance imaging in the management of acute spinal cordinjury. J Neurotrauma 2011;28:1401‑11.
36. Goradia D, Linnau KF, Cohen WA, Mirza S, Hallam DK,Blackmore CC. Correlation of MR imaging findings withintraoperative findings after cervical spine trauma. AJNR Am JNeuroradiol 2007;28:209‑15.
37. Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ,Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR Am J Neuroradiol 2002;23:794‑802.
38. Huisman TA. Diffusion‑weighted imaging: Basic conceptsand application in cerebral stroke and head trauma. Eur Radiol2003;13:2283‑97.
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Copyright (c) 2021 Jeneral Dumura Alfin, Ayodeji Salman Yusuf, Raji Mohammed Mahmud, Danaan Joseph Shilong, Gyang Markus Bot, Simon J. Yiltok (Author)
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