Prognostic utility of magnetic resonance imaging (MRI) in predicting neurological outcomes in patients with acute thoracolumbar spinal cord injury

Abstract

Purpose

Utility of MRI for predicting neurological outcomes in acute cervical spinal cord injury (SCI) is well established but its value in thoracolumbar (TL) SCI needs to be evaluated.

Methods

Seventy-six patients operated for acute TL spinal injuries between January 2014 and March 2016 were reviewed to obtain demographic details, neurology at admission and at the final follow-up. Patients were divided based on the neurology at presentation into group 1 (ASIA A), group 2 (ASIA B, C, D) and group 3 (normal neurology). Preoperative MRI and CT scans were evaluated to measure parameters like osseus canal compromise, spinal cord compression (SCC), spinal cord swelling, length of cord swelling (LOS), length of edema (LOE) and the presence of hemorrhage. The MRI parameters were compared between the groups for their predictive value of neurology on admission and at the final follow-up.

Results

Of the 38 patients in group 1, six patients recovered by 1 grade, nine patients recovered by 2 grades and there was no recovery in 23 (60.5%) patients. Among group 2 patients, nine (40.9%) out of 22 recovered to ASIA E neurology. On univariate analysis, SCC (P = 0.009), LOS (P = 0.021) and length of edema (P = 0.002) were associated with complete neurological deficit at presentation. However, on multivariate regression analysis only LOE was significant (P = 0.007) in predicting neurology at admission and at follow-up.

Conclusion

Greater the rostrocaudal LOE, worse is the neurology at presentation, and it is associated with poor neurological recovery at follow-up.

Graphic abstract

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References

  1. 1.

    Mabray MC, Talbott JF, Whetstone WD, Dhall SS et al (2016) Multidimensional analysis of magnetic resonance imaging predicts early impairment in thoracic and thoracolumbar spinal cord injury. J Neurotrauma 33(10):954–962

    Article  Google Scholar 

  2. 2.

    Roberts TT, Leonard GR, Cepela DJ (2017) Classifications in brief: American spinal injury association (ASIA) impairment scale. Clin Orthop Relat Res 475(5):1499–1504

    Article  Google Scholar 

  3. 3.

    Martin AR, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N et al (2016) Translating state-of-the-art spinal cord MRI techniques to clinical use: a systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. NeuroImage Clin 10:192–238

    Article  Google Scholar 

  4. 4.

    Flanders AE, Spettell CM, Friedman DP, Marino RJ, Herbison GJ (1999) The relationship between the functional abilities of patients with cervical spinal cord injury and the severity of damage revealed by MR imaging. Am J Neuroradiol 20(5):926–934

    CAS  PubMed  Google Scholar 

  5. 5.

    Kulkarni MV, Bondurant FJ, Rose SL, Narayana PA (1988) 1.5 tesla magnetic resonance imaging of acute spinal trauma. Radiographics 8(6):1059–1082

    CAS  Article  Google Scholar 

  6. 6.

    Selden NR, Quint DJ, Patel N, d’Arcy HS, Papadopoulos SM (1999) Emergency magnetic resonance imaging of cervical spinal cord injuries: clinical correlation and prognosis. Neurosurgery 44(4):785–792

    CAS  Article  Google Scholar 

  7. 7.

    Gupta R, Mittal P, Sandhu P, Saggar K, Gupta K (2014) Correlation of qualitative and quantitative MRI parameters with neurological status: a prospective study on patients with spinal trauma. J Clin Diagn Res 8(11):13–17

    Google Scholar 

  8. 8.

    Marciello MA, Flanders AE, Herbison GJ, Schaefer DM, Friedman DP, Lane JI (1993) Magnetic resonance imaging related to neurologic outcome in cervical spinal cord injury. Arch Phys Med Rehabil 74(9):940–946

    CAS  PubMed  Google Scholar 

  9. 9.

    Ramon S, Dominguez R, Ramirez L, Paraira M, Olona M, Castello T, Fernandez LG (1997) Clinical and magnetic resonance imaging correlation in acute spinal cord injury. Spinal Cord 35(10):664

    CAS  Article  Google Scholar 

  10. 10.

    Skeers P, Battistuzzo CR, Clark JM, Bernard S, Freeman BJ, Batchelor PE (2018) Acute thoracolumbar spinal cord injury: relationship of cord compression to neurological outcome. JBJS 100(4):305–315

    Article  Google Scholar 

  11. 11.

    Fehlings MG, Rao SC, Tator CH, Skaf G, Arnold P et al (1999) The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury: part II: results of a multicenter study. Spine 24(6):605–613

    CAS  Article  Google Scholar 

  12. 12.

    Furlan JC, Fehlings MG, Massicotte EM, Aarabi B, Vaccaro AR et al (2007) A quantitative and reproducible method to assess cord compression and canal stenosis after cervical spine trauma: a study of interrater and intrarater reliability. Spine 32(19):2083–2091

    Article  Google Scholar 

  13. 13.

    Fehlings MG, Furlan JC, Massicotte EM, Arnold P et al (2006) Interobserver and intraobserver reliability of maximum canal compromise and spinal cord compression for evaluation of acute traumatic cervical spinal cord injury. Spine 31(15):1719–1725

    Article  Google Scholar 

  14. 14.

    Vaccaro AR, Lehman RA, Hurlbert RJ, Anderson PA, Harris M, Hedlund R et al (2005) A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 30(20):2325–2333

    Article  Google Scholar 

  15. 15.

    Shimada K, Tokioka T (1999) Sequential MR studies of cervical cord injury: correlation with neurological damage and clinical outcome. Spinal Cord 37(6):410

    CAS  Article  Google Scholar 

  16. 16.

    Dumont RJ, Okonkwo DO, Verma S, Hurlbert RJ, Boulos PT, Ellegala DB, Dumont AS (2001) Acute spinal cord injury, part I: pathophysiologic mechanisms. Clin Neuropharmacol 24(5):254–264

    CAS  Article  Google Scholar 

  17. 17.

    Miyanji F, Furlan JC, Aarabi B, Arnold PM, Fehlings MG (2007) Acute cervical traumatic spinal cord injury: MR imaging findings correlated with neurologic outcome—prospective study with 100 consecutive patients. Radiology 243(3):820–827

    Article  Google Scholar 

  18. 18.

    Pickett GE, Campos-Benitez M, Keller JL, Duggal N (2006) Epidemiology of traumatic spinal cord injury in Canada. Spine 31(7):799–805

    Article  Google Scholar 

  19. 19.

    Sekhon LH, Fehlings MG (2001) Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 26(24S):S2–S12

    CAS  Article  Google Scholar 

  20. 20.

    Katsuura Y, Osborn JM, Cason GW (2016) The epidemiology of thoracolumbar trauma: a meta-analysis. J Orthop 13(4):383–388

    Article  Google Scholar 

  21. 21.

    Panjabi MM, Kifune M, Wen L, Arand M, Oxland TR, Lin RM, Yoon WS, Vasavada A (1995) Dynamic canal encroachment during thoracolumbar burst fractures. J Spinal Disord 8(1):39–48

    CAS  Article  Google Scholar 

  22. 22.

    Kearny PA, Ridella SA, Viano DC, Anderson TE (1988) Interaction of contact velocity and cord compression in determining the severity of spinal cord injury. J Neurotrauma 5(3):187–208

    Article  Google Scholar 

  23. 23.

    Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF, Northrup BE (1990) Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology 177(1):25–33

    CAS  Article  Google Scholar 

  24. 24.

    Yashon D, Bingham WG Jr, Faddoul EM, Hunt WE (1973) Edema of the spinal cord following experimental impact trauma. J Neurosurg 38(6):693–697

    CAS  Article  Google Scholar 

  25. 25.

    Leypold BG, Flanders AE, Burns AS (2008) The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury. Am J Neuroradiol 29(5):1012–1016

    CAS  Article  Google Scholar 

  26. 26.

    Leonard AV, Thornton E, Vink R (2015) The relative contribution of edema and hemorrhage to raised intrathecal pressure after traumatic spinal cord injury. J Neurotrauma 32(6):397–402

    Article  Google Scholar 

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Correspondence to Ajoy Prasad Shetty.

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Naduvanahalli Vivekanandaswamy, A., Kannan, M., Sharma, V. et al. Prognostic utility of magnetic resonance imaging (MRI) in predicting neurological outcomes in patients with acute thoracolumbar spinal cord injury. Eur Spine J 29, 1227–1235 (2020). https://doi.org/10.1007/s00586-019-06135-6

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Keywords

  • Spinal cord injury
  • Spine trauma
  • Magnetic resonance imaging
  • Outcomes
  • Neurological
  • Recovery