The Prevalence Non-Adjacent Cervical Cord Injury in an Irish Population

Abstract

Objective: To analyze the prevalence of non-contiguous injury of spinal cord using MRI with a focus on cervical spinal injury patients. Methods: 60 cervical spinal injury patients were reviewed using the NIMIS (National Integrated Medical Imaging System) system. The MR imaging and imaging reports for cervical spinal injury were reviewed in a University Teaching Hospital in West Ireland (45 male and 15 female). The mean age of patients in this population group was 42. They were divided into three groups based on the mechanism of injury; hyperflexion, hyperextension and axial injury as per ASIA guidelines. The presence or absence of non-contiguous spinal injury was confirmed as to whether there was marrow contusion, herniation, or fracture at any area along the spine. During evaluation of spinal injury the cervical spine is often prioritized, however the importance of surveying the entire spine is essential. It has been emphasized that the whole cervical spine including the cervicothoracic junction (CTJ) Results: A total of 9 cases (15%) showed CTJ or upper thoracic spinal injuries defined as C7-L1 injury. 2 of 21 cases revealed obvious fractures in the CTJs or upper thoracic spines. Ligamentous injury in these regions was found in only one case, Traumatic disc herniation in four cases and spinal cord injury in five cases. Nerve impingement was observed in two cases. The incidence of non-contiguous spinal injuries was higher in the axial compression injury group (25%) than in the hyperflexion injury group (21%) or the hyperextension (20%) injury group, highlighting the importance of injury mechanism. Conclusion: Cervical spinal MR showed non-contiguous CTJ or upper thoracic spinal injuries in 28% of the patients with cervical spinal injury. The mechanism of cervical spinal injury did not significantly affect the incidence of the noncontiguous CTJ or upper thoracic spinal injury. Physicians in Ireland should consider imaging other areas of the spine when a cervical spinal injury is suspected.