Highlights
- •Prospective multi-centre study, traumatic spinal cord injury including cervical and thoracic, n = 120.
- •Magnetic resonance imaging of all patients.
- •Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge, including haematoma.
- •Thoracic injury, haematoma, and MSCC >25% gave ∼ 90% probability of AIS grade A at discharge – no change from admission.
Abstract
Study design
Prospective observational cohort study linked with administrative data.
Objectives
Magnetic Resonance Imaging (MRI) is routinely performed after traumatic spinal cord
injury (TSCI), facilitating early, accurate diagnosis to optimize clinical management.
Prognosis from early MRI post-injury remains unclear, yet if available could guide
early intervention. The aim of this study was to determine the association of spinal
cord intramedullary haematoma and/or extent of cord compression evident on initial
spine MRI with neurological grade change after TSCI.
Methods
Individuals with acute TSCI ≥16 years of age; MRI review. Neurological gradings (American
Spinal Injury Association Impairment Scale (AIS)) were compared with initial MRI findings.
Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge.
Results
120 subjects; 79% male, mean (SD) age 51.0 (17.7) years. Motor vehicle crashes (42.5%)
and falls (40.0%) were the most common injury mechanisms. Intramedullary spinal cord
haematoma was identified by MRI in 40.0% of patients and was associated with more
severe neurologic injury (58.3% initially AIS A). Generalised linear regression showed
higher maximum spinal cord compression (MSCC) was associated with lower likelihood
of neurological improvement from initial assessment to follow up prior to rehabilitation
discharge. Combined thoracic level injury, intramedullary haematoma, and MSCC > 25%
resulted in almost 90% probability of pre-discharge AIS (grade A) remaining unchanged
from admission assessment.
Conclusions
MRI is a vital tool for evaluating the severity and extent of TSCI, assisting in appropriate
management decision-making early in TSCI patient care. This study adds to the body
of knowledge assisting clinicians in prognostication.
Keywords
Abbreviations:
AIS (American Spinal Injury Association Impairment Scale), MCC (Maximum Canal Compression), MSCC (Maximum Spinal Cord Compression), MRI (Magnetic Resonance Imaging), TSCI (Traumatic Spinal Cord Injury), ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 10, 2022
Accepted:
October 4,
2022
Received in revised form:
September 26,
2022
Received:
May 2,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
