MRI Prognostication factors in the setting of cervical spinal cord injury secondary to trauma

• Published in: World neurosurgery 2017-05, Vol.101, p.623-632
• Main Authors: Martínez-Pérez, Rafael, MD, Cepeda, Santiago, MD, Paredes, Igor, MD. PhD. FEBNS, Alen, Jose F., MD. PhD, Lagares, Alfonso, MD. PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Cervical; Cervical Vertebrae - diagnostic imaging; Cohort Studies; Edema - diagnostic imaging; Edema - etiology; Female; Follow-Up Studies; Humans; Joint Dislocations - diagnostic imaging; Joint Dislocations - etiology; Magnetic Resonance Imaging - methods; Male; Middle Aged; MRI; Neurologic recovery; Neurosurgery; Outcome; Prognosis; Prognostic; Prospective Studies; Retrospective Studies; Spinal Cord Injuries - diagnostic imaging; Spinal Cord Injuries - etiology; Spinal cord injury; Spine; Spine trauma; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.02.034

Abstract Background and Purpose: Several studies have looked for an association between radiological findings and neurological outcome after cervical trauma. In the current literature, there is a paucity of evidence proving the prognostic role of soft tissue damage or bony integrity. Our objective is to determine radiological findings related to neurological prognosis in patients after incomplete acute traumatic cervical spinal cord injury, regardless of initial neurological exam. Material and Methods We retrospectively reviewed patients with acute traumatic cervical Spinal Cord Injury who had an MRI performed within the first 96 hours. Clinical and epidemiological data were recorded from the medical records along with several radiological findings from the initial CT scan and MRI. Data was analyzed using non-parametric test. Significant prognostic factors were analyzed through a stepwise multivariable logistic regression, adjusted by neurological status at baseline. The receiver-operating characteristic curve (ROC curve) was used to test the discriminative capacity of the model. Results 86 cases (68 males and 18 females) were included for the analysis. Mean age was 49 years old. Ligamentum flavum injury, intramedullary edema larger than 36 mm and facet dislocation demonstrated to be associated with a lack of neurological improvement at follow up. Multivariable analysis showed that edema larger than 36 mm and facet dislocation were strong predictors of clinical outcome, regardless of the initial neurological examination. Conclusion Early MRI has an intrinsic prognostic value. Ligamentous injury and larger edema are strong predicting factors of a bad neurological outcome at long term follow-up.