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Abstract
Study design
Retrospective evaluation of MRI and clinical examinations in 60 acute cervical spine cord injury.
Objectives
To determine whether initial MRI appearances of the spinal cord in acute trauma correlate with clinical presentation and prognosis.
Summary of Literature Review
Magnetic resonance imaging was known to be the best imaging modality to evaluate spinal cord injury. However, there was no sufficient report to correlate between clinical presentation, prognosis and findings of magnetic resonance imaging.
Methods
Sixty patients with cervical SCI were evaluated their clinical manifestations, prognosis and MRI findings. MRI was taken with 10 days after trauma in all patients. The patients initial and final neurologic status and functional outcome were evaluated and correlation with initial MRI findings.
Results
Edema 37%, swelling 33%, contusion 20%, normal 10% was found at initial magnetic resonance imaging. The group of edema and swelling was more neurological deficit than other groups and low functional and neurological recovery was found at last follow up. The average length of the edema and swelling was each other 19.8, 20.4 mm. There was more neurological deficit, lower functional recovery in longer length of the edema and swelling.
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REFERENCES
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Figures and Tables%
 | Fig. 1.Spinal cord edema; 35-year-old woman presenting Frankel grade D; MRI was performed 5 days from injury. Fig. A. Sagittal midline T1-weighted image demonstrated isointense signal in the cord opposite C5-6 associated with fracture C6 spinous process. Fig. B. T2-weighted image shows diffuse high signal in cord from C5 to C6 |
 | Fig. 2.Spinal cord swelling; 44-year-old man presenting Franke B; MRI was performed at 2 days from injury. Fig. A. Sagittal middle T1-weighted image demonstrates C4/5 subluxation and isointense signal with cord distension opposite C4-5. Fig. B. T2-weighted image shows diffuse hyperintense signal in cord from C2 to C6 with C4-5 interspinous and supraspinatus ligament rupture. |
 | Fig. 3.Spinal cord contusion. 25-year-old man presenting Frankel B; MRI was performed 2 days from injury. Fig. A. Sagittal midline T1-weighted image demonstrates focal cord compression and isointense signal in the cord opposite C5 associated compression fracture of C5 vertebral body. Fig. B. T2-weighted image shows diffuse heterogenous hyperintense signal from C3 to C6. |
 | Fig. 4.41-year-old man presenting Frankel C; MRI was performed 2 days from injury. Fig. A. Preop T1-weighted image demonstrates isointense signal in cord opposite C4-5 associated with C4-5 disc rupture which migrate to the C4 vertebral body and C5-6 disc protrusion. Fig. B. Preop T2-weighted image shows diffuse hyperintense signal change in cord from C4 to C6. Fig. C. Postop T1-weighted image which performed 19 month from injury, was demonstrates focal hypointense signal change in the cord at C4-5 level with anterior cervical disectomy and fusion at C4-5-6. Fig. D. Postop T2-weighted image shows focal hyperintense signal in cord opposite C4-5. |
Table 1.
Demographic Characteristics
| No. of Patients (%) | ||
|---|---|---|
| 10~19 | Age(year) | 4 (16.7) |
| 20~39 | 24 (39.9) | |
| 40~59 | 26 (43.4) | |
| 60~ | 6 (10.0) | |
| Injury mechanism | ||
| Motor vehicle accident | 40 (66.7) | |
| Fall down | 14 (23.3) | |
| Slip & Rolling down | 5 (18.3) | |
| Others | 1 (11.7) | |
| C2 | Injury level | 1 (11.7) |
| C3 | 5 (18.3) | |
| C4 | 8 (13.3) | |
| C5 | 19 (31.7) | |
| C5 C6 | 19 (31.7)18 (30.0) | |
| C7 | 9 (15.0) | |
| Diagnostic finding | ||
| Fx.∗ | 15 (25.0) | |
| S/L† | 19 (31.7) | |
| Fx. & S/L | 22 (36.7) | |
| HCD‡ | 4 (16.7) | |
Table 2.
Treatment Methods
| Procedure | No. of Patients (% |
|---|---|
| Conservative | 19 (31.7) |
| Discectomy/fusion | 22 (36.7) |
| Corpectomy/fusion | 15 (25.0) |
| Post. fusion | 2 (13.3) |
| Combined ant/post fusion | 2 (13.3) |
Table 3.
ASIA Motor Score
| Edema | Swelling | Contusion | Normal | |
|---|---|---|---|---|
| Initial | 48.6 | 47.8 | 52.7 | 57.8 |
| Followup | 63.7 | 61.4 | 76.7 | 77.9 |
Table 4.
The distribution of patient according to Frankel Grade
| Edema | Swelling | Contusion | Normal | |
|---|---|---|---|---|
| Initial | A 5 | 2 | 1 | 1 |
| B 2 | 1 | 2 | 0 | |
| C 4 | 3 | 3 | 3 | |
| D 11 | 14 | 6 | 2 | |
| Followup | A 4 | 1 | 0 | 0 |
| B 2 | 0 | 0 | 0 | |
| C 4 | 4 | 1 | 0 | |
| D 9 | 2 | 0 | 1 | |
| E 3 | 3 | 11 | 5 |
Table 5.
Correlation between edema, swelling and Frankel grade
| Change of Frankel grade | Edema | Swelling | Contusion | Normal |
|---|---|---|---|---|
| Absent | 15∗ | 16∗ | 4 | 1 |
| Present | 7 | 6 | 8 | 5 |
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