Computed tomography predictors of adult spinal cord injury without radiographic abnormality.

Abstract

Elasticity of the skeletal system in children and degenerative changes in adults are responsible for SCIWORA. The purpose of this study was to determine those degenerative changes on CT scan that predispose adults to SCIWORA, their correlation with MRI findings, clinical presentation and recovery. This prospective study was conducted over a period of 1.5 years and 30 patients were enrolled. Apart from the demographic profile, mode of injury, clinical symptoms, ASIA at admission, X-ray, CT and MRI findings were noted. All patients were managed conservatively and were followed up after 3 months. NCCT and MRI findings were correlated with each other, with clinical presentation and with recovery. Recovery was defined as any improvement in ASIA class. Data was collected and organized. For normally distributed data parametric test and for others non-parametric test was used. Kendall tau rank correlation coefficient was used to measure the ordinal association between two measured quantities. 28 (93.3%) patients were males and 2 (6.7%) were females. Patients with osteoporosis and/or osteophytes (n = 16) had a higher incidence of development of cord edema or non-haemorrhagic contusion (n = 15) (P = 0.028) while patients with canal stenosis and/or ligamentous calcification (n = 14) had a higher incidence of development of haemorrhagic contusion (n = 12) (P = 0.04). Patients with canal stenosis and/or ligament calcification showed significantly less recovery (n = 3) when compared with patients of osteophytes and/or osteoporosis (n = 6) (P = 0.04). Disc abnormality was seen in 1 patient only. 9 patients showed recovery and maximum recovery was seen in ASIA D (n = 4) class while no patient recovered in ASIA A class. Osteoporosis, osteophytes, canal stenosis and ligament calcification are the factors that predispose adults to SCIWORA. The final outcome seems to be poorer in cases of canal stenosis when compared with osteophytes and osteoporosis. NCCT findings can be used as an adjunct to MRI to predict clinical presentation, severity and recovery in adult SCIWORA.