A prospective serial MRI study following acute traumatic cervical spinal cord injury

Joost P H J Rutges,Tamir Ailon,Brian K Kwon,Manraj Heran,John T Street,Marcel F Dvorak

doi:10.1007/s00586-017-5097-4

Abstract

PurposeIn acute traumatic cervical spinal cord injury (SCI) patients, we sought to characterize how objective MRI measures of injury change during the first 3 week post-injury.MethodsSix MRI scans each were planned in 19 cervical SCI patients within the first 3 week post-injury. Length of cord edema, maximum spinal cord compression, maximum canal compromise, and presence and length of hematoma were measured.ResultsLength of spinal cord edema increased in the first 48 h after SCI, followed by a gradual decrease in the 3 weeks after injury. This was predominantly seen in the more severe grades of SCI. Hematoma in the spinal cord was seen in all AIS-A and B patients.ConclusionThis study demonstrates the dynamic nature of imaging changes on MRI in the first weeks after injury and highlights the importance of taking into account the timing of imaging when interpreting objective measures of damage.

Highlights

Acute traumatic spinal cord injury (SCI) is a devastating condition with an annual incidence ranging from 8.0 to 57.8 per million worldwide [1, 2]
Hematoma in the spinal cord was seen in all Association Impairment Scale (AIS)-A and B patients
One patient withdrew after the initial magnetic resonance imaging (MRI) because of claustrophobia, and MRI scans from 19 patients were available for analysis

Summary

Introduction

Acute traumatic spinal cord injury (SCI) is a devastating condition with an annual incidence ranging from 8.0 to 57.8 per million worldwide [1, 2]. Magnetic resonance imaging (MRI) has routinely been used in the acute setting to characterize the injury and assist in surgical planning. There has been much interest in utilizing objective measures derived from MRI scans to characterize the severity of neurologic impairment and to predict outcome. The large heterogeneity amongst SCI patients, especially with regard to extent of neurological deficit, injury pattern, overall injury severity, comorbidities, surgical strategies, and rehabilitation care, makes prediction of neurological outcome very difficult [3]. Current methods for predicting outcome based on the initial functional neurologic examination are limited, and there is a great need for objective measures to better classify injury severity and predict outcome. It has been suggested that the extent of spinal cord edema is dynamic in the first days after SCI, based on

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Conclusion