Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging

Abstract

Background We evaluated the prognostic and clinical value of radiological findings including prevertebral hyperintensity (HI), cord compression, intramedullary high-signal intensity (IMHSI) and instability in patients with traumatic central cord syndrome without evidence of fracture and dislocation. Methods The radiological and clinical findings of 23 patients who had undergone surgery between 1996 and 2002 were reviewed retrospectively. All of the patients underwent dynamic motion study and magnetic resonance (MR) imaging after trauma. Neurologic status was evaluated with American Spinal Injury Association motor score pre- and postoperatively and compared with the radiological findings. Anterior decompression and fusion were performed in 12 patients with 1- or 2-level lesions, and posterior decompression was done for 11 cases of multilevel lesions. Results Prevertebral HI was found in 17 patients. Among them, instability was revealed in 11 patients. There was significant correlation between prevertebral HI and instability ( P = .014). Cord compression was found in varying degrees in all patients on MR imaging. Intramedullary high-signal intensity was found preoperatively in 19 (83%) of 23 patients, and it was revealed at the most compressed level of the spinal cord in all cases. The neurologic level was consistent with the level of instability (100%), IMHSI (95%), and cord compression (87%). Mean American Spinal Injury Association motor scores in patients with instability were lower than in those without instability ( P < .05). Conclusions The presence of prevertebral HI, IMHSI, and cord compression influenced the neurologic status of the patients. The instability was significantly associated with poor prognosis for neurologic outcome. Prevertebral HI on T2 MR imaging may be a possible indicator of instability in patients with central cord syndrome after hyperextension injury.