SA Orthopaedic Journal
On-line version ISSN 2309-8309
TER HAAR, M et al. Acute traumatic cervical spinal cord injuries: correlating MRI findings with neurological outcome. SA orthop. j. [online]. 2011, vol.10, n.1, pp. 35-41. ISSN 2309-8309.
STUDY DESIGN: Retrospective, observational, cohort study. OBJECTIVES: To evaluate whether quantitative and qualitative magnetic resonance imaging (MRI) assessments after acute traumatic cervical spinal cord injuries (SCI) correlate with the patient's neurological status and if they are predictive of outcome at long-term follow-up. MATERIALS AND METHODS: Eighty-eight patients (77 male, 11 female) with traumatic cervical spinal cord injuries who were admitted to the spinal unit, were evaluated over a period of five years (Jan 2004-Dec 2008). Neurological impairment was classified using the Frankel classification both on admission and discharge. MR imaging was done on all patients using both T1-and T2-weighted sagittal scans, axial T2-weighted scans and axial gradient recalled echo imaging (for evaluation of haemorrhage). Three quantitative imaging parameters (maximum spinal cord compression [MSCC], maximum canal compromise [MCC], and length of lesion) as well as five qualitative parameters (intramedullary haemorrhage, cord oedema, cord swelling, disc herniation and soft tissue injury) were evaluated and correlated to the patients' neurological outcome. RESULTS: Patients with a complete motor and sensory SCI (Frankel A) had higher frequencies of intramedullary haemorrhage (p<0.001), cord swelling (p=0.002) and cord oedema (p<0.001) compared to the incomplete SCI (Frankel grade B, C and D) and those without any neurology (Frankel grade E). Patients with complete SCI also had a more substantial MSCC (p=0.008), MCC (p=0.009) and lesion length (p=0.001) compared to the other two groups. The length of lesion (p=0.019) and intramedullary haemorrhage (p=0.001) correlate with baseline neurology. MSCC (p=0.063), length of lesion (p=0.011) and intramedullary haemorrhage (p=0.036) were predictive of a poor neurological outcome. CONCLUSION: The study demonstrated MR imaging to be a useful tool in prognosticating a patient's potential for neurological recovery. It indicated that MSCC, length of lesion and intramedullary haemorrhage are associated with a poor prognosis for neurological recovery.