A prospective study of neurological outcome in relation to findings of imaging modalities in acute spinal cord injury

Asian Journal of Neurosurgery, 2015 · DOI: 10.4103/1793-5482.161166 · Published: July 1, 2015

Spinal Cord Injury Neuroimaging Neurology

Simple Explanation

Acute traumatic spinal cord injury (SCI) is a devastating injury, especially prevalent in the younger population, leading to various burdens on the individual and society. Assessing the spine quickly and accurately for injuries or instability is the first priority. Cross-sectional imaging is the primary investigation for patients unable to undergo a satisfactory neurological examination. Imaging techniques such as plain radiography, CT, and MRI are used to evaluate the spinal column. CT scans are more time-efficient and sensitive for fracture detection. MRI offers superior tissue characterization and direct evaluation of the spinal cord, helping to assess discs, ligaments, hematomas, and the spinal cord. Recovery after SCI is possible through resolution of acute injury events and secondary pathophysiological processes, as well as regrowth or regeneration of nervous tissue. This study aims to analyze imaging findings in acute spinal injury patients and correlate them with clinical profiles and neurological recovery.

Study Duration

May 2011 and December 2013

Participants

25 patients of acute SCI

Evidence Level

Not specified

Key Findings

1
Patients with complete SCI had significantly more compression percentage, maximum canal compromise and maximum spinal cord compression at presentation.
2
Qualitative MRI findings such as hemorrhage, cord swelling, and stenosis showed a predilection toward complete SCI. Improvement in canal dimensions, beck index, spinal cord edema and stenosis was more significant in patients managed operatively, but it was not associated with improved neurological outcome.
3
Imaging findings of severe kyphotic deformities, higher canal and cord compression, lesion length, hemorrhage, and cord swelling are associated with poor initial neurological status and recovery. Quantitative and qualitative parameters measured on MRI have a significant role in predicting initial severity of neurological status and outcome.

Research Summary

This prospective study correlated clinical profiles and neurological outcomes with imaging findings in 25 acute SCI patients. Imaging features from radiographs, CT, and MRI were analyzed and correlated with clinical and neurological outcomes at presentation, 3, 6, and 12 months. The study found that patients with complete SCI had significantly more compression and canal compromise compared to those with incomplete SCI. Qualitative MRI findings like hemorrhage and cord swelling were more common in complete SCI. Operative management improved canal dimensions but not neurological outcome. The study concludes that imaging modalities play a major role in diagnosing, directing management, and predicting prognosis in spinal cord injuries. Severe kyphotic deformities, higher canal and cord compression, and specific MRI findings are associated with poor neurological outcomes.

Practical Implications

Diagnostic Tool

Imaging modalities, particularly MRI, are essential for diagnosing and assessing the severity of acute spinal cord injuries.

Prognostic Indicator

Quantitative and qualitative MRI parameters can help predict the initial severity and potential neurological outcomes in SCI patients.

Management Guidance

Imaging findings can guide the management approach, although operative intervention may not always translate to improved neurological outcomes.

Study Limitations

1
The study included only 25 patients, which may limit the generalizability of the findings.
2
The study was conducted at a single center.
3
The long-term effects beyond one year were not evaluated.

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