Evaluation of patients with cervical spine injury and predicting the risk and severity of acute spinal cord injury after a minor trauma (original) (raw)
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Clinical, Radiographic and Magnetic Resonance Imaging Evaluation of Cervical Spine Trauma
International Journal of Anatomy Radiology and Surgery, 2016
Introduction: Cervical spine trauma occurs in 1.5 to 3% of patients with major trauma and in 10% of patients with major trauma and serious head injury. Imaging plays an important role in the diagnosis of spinal injuries. The various modalities used to evaluate cervical spine are plain radiography, computed tomography, CT myelography, intraoperative sonography and magnetic resonance imaging. Aim: This study compares the usefulness of conventional radiography and MR imaging in the diagnosis of acute cervical spine trauma. Materials and Methods: This prospective analytical study was carried out on 58 patients with history of cervical spine trauma. Evaluation was done on plain radiography and MR imaging. Findings were recorded on both the modalities and clinical correlation was done. Results: In this study, 94.83% were males. Hyperflexion injuries were seen in 37.93% patients.C6 vertebral fracture was seen in 12% patients. Herniation of the disc was commonly seen at C4-5 and C5-6 disc level on MRI. 64 levels were found to be affected with simple cord edema. Conclusion: MRI combined with plain radiographs provides an accurate and non invasive modality for evaluation of patients with cervical spine trauma.
World neurosurgery, 2017
Spinal cord injury (SCI) without computed tomography evidence of trauma is underreported in adults and is considered a subtype of SCI with relatively good outcome. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Our objective is to describe the imaging characteristics of patients experiencing blunt cervical spine trauma with neurologic deficits, but without radiologic abnormalities and associated prognostic factors. A retrospective review of all adult patients with cervical SCI admitted to the emergency room of 2 university hospitals from January 2004 to December 2013 was performed. Only patients with a magnetic resonance imaging (MRI) performed within 72 hours after trauma were included for further analysis. All patients with bony injury or traumatic malalignment were excluded. Data gathered on the remaining patients included demographics, mechanism of injury, severity of SCI, long-term patient outcome, improvement in neurolog...
A prospective serial MRI study following acute traumatic cervical spinal cord injury
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017
In acute traumatic cervical spinal cord injury (SCI) patients, we sought to characterize how objective MRI measures of injury change during the first 3 week post-injury. Six MRI scans each were planned in 19 cervical SCI patients within the first 3 week post-injury. Length of cord edema, maximum spinal cord compression, maximum canal compromise, and presence and length of hematoma were measured. Length of spinal cord edema increased in the first 48 h after SCI, followed by a gradual decrease in the 3 weeks after injury. This was predominantly seen in the more severe grades of SCI. Hematoma in the spinal cord was seen in all AIS-A and B patients. This study demonstrates the dynamic nature of imaging changes on MRI in the first weeks after injury and highlights the importance of taking into account the timing of imaging when interpreting objective measures of damage.
The Journal of Emergency Medicine, 1998
e Abstract-A 65-year-old inebriated man crashed his car and presented with spinal shock and neurogenic shock from a cervical spinal cord injury without cervical spine fracture or dislocation. The lateral cervical spine radiography was initially read as normal, except for degenerative disk disease; however, Torg's ratio method of analyzing cervical spinal canal sagittal width indicated the spinal canal was congenitally narrow. Magnetic resonance imaging confirmed this and showed bulging and herniation of multiple invertebral disks between C2 and C7. This case illustrates the value of using Torg's ratio method of analyzing lateral cervical spine radiographs. Although Torg's method has not been prospectively validated, it may be useful to identify patients at risk for cervical spinal cord injuries without fractures or dislocations. An abnormal Torg's ratio may be the only clue to the fact that the patient is at higher risk of spinal cord injury when the patient's history or examination is questionable because of head injury, drug intoxication, or therapeutic sedation and paralysis. © 1998 Elsevier Science Inc.
Can MRI findings predict the outcome of cervical spinal cord Injury? a systematic review
European Spine Journal, 2020
Introduction MRI is the established gold standard for imaging acute spinal cord injury (SCI). Our aim was to identify the prognostic value, in terms of neurological outcome, of extradural and intradural features detected on MRI performed acutely following traumatic cervical SCI. Materials and methods Several databases were systematically searched to identify potentially eligible articles until December 2019. Using a standard PRISMA template, 2606 articles were initially identified. Results A final 6 full-text articles met the inclusion criteria and were analyzed. An extradural factor, namely the maximal spinal cord compression, was associated with poor neurological outcome and statistically significant (P = 0.02 and P = 0.001 in 2 out of 3 studies). The intradural factors of length of the cord edema (P = 0.001, P = 0.006, and P < 0.001 in 3 studies), intramedullary hemorrhage (P = 0.002, P < 0.001, P < 0.001, and P = 0.002 in 4 studies), and the length of intramedullary hemorrhage (P = 0.028, P = 0.022 in 2 studies) also significantly correlated with poor neurological recovery at follow-up. Conclusion While early MRI is established as a gold standard imaging of acute spinal trauma, it also serves to provide prognostic value on the neurological recovery. From our systematic review, there is a strong association of the extradural finding of maximal spinal cord compression, intradural MRI findings of length of cord edema, intramedullary hemorrhage, and length of intramedullary hemorrhage with neurological recovery in traumatic cervical spinal cord injuries. Level of evidence III
A Prospective Study on Acute Cervical Spine Injury
Background: Injury to the spine and spinal cord is one of the common cause of disability and death. Several factors affect the outcome; but which are these factors (alone and in combination), are determining the outcomes are still unknown. The aim of the study was to evaluate the factors influencing the outcome following acute cervical spine injury. Materials and Methods: A prospective observational study at single‑ center with all patients with cervical spinal cord injury (SCI), attending our hospital within a week of injury during a period of October 2016 to July 2017 was included for analysis. Demographic factors such as age, gender, etiology of injury, preoperative American Spinal Injury Association (ASIA) grade, upper (C2‑C4) versus lower (C5‑C7) cervical level of injury, imageological factors on magnetic resonance imaging (MRI), and timing of intervention were studied. Change in neurological status by one or more ASIA grade from the date of admission to 6 months follow‑up was taken as an improvement. Functional grading was assessed using the functional independence measure (FIM) scale at 6 months follow‑up. Results: A total of 39 patients with an acute cervical spine injury, managed surgically were included in this study. Follow‑up was available for 38 patients at 6 months. No improvement was noted in patients with ASIA Grade A. Maximum improvement was noted in ASIA Grade D group (83.3%). The improvement was more significant in lower cervical region injuries. Patient with cord contusion showed no improvement as opposed to those with just edema wherein; the improvement was seen in 62.5% patients. Percentage of improvement in cord edema ≤3 segments (75%) was significantly higher than edema with >3 segments (42.9%). Maximum improvement in FIM score was noted in ASIA Grade C and patients who had edema (especially ≤3 segments) in MRI cervical spine. Conclusions: Complete cervical SCI, upper‑level cervical cord injury, patients showing MRI contusion, edema >3 segments group have worst improvement in neurological status at 6 months follow‑up.
Acute Cervical Spine Trauma: Evaluation with 1.5-T MR Imaging
Twenty-one patients with acute neurologic deficits following cervical spine trauma were evaluated with magnetic resonance (MR) imaging (n = 21), computed tomography enhanced with intrathecal contrast material (CT myelography) (n = 18), myelography (n = 13), cervical spine radiography (n = 21), and intraoperative sonography (n = 7). MR imaging proved superior to other modalities in demonstrating parenchymal spinal cord injuries and cervical intervertebral disk herniation. Although both T1- and T2-weighted studies appear necessary to evaluate the anatomic relationship of the spinal cord, thecal space, intervertebral disks, and surrounding osseous and ligamentous structures, T2-weighted sequences were more sensitive than T1-weighted studies for detection of spinal cord injury. CT myelography was superior to MR imaging in demonstrating cervical spine fractures. In most cases, myelography revealed no information that was not apparent from both CT and MR imaging studies. Preliminary experience with MR imaging of acute cervical spine trauma suggests that it should be the study of choice in symptomatic patients who are otherwise clinically stable. CT may still be required in selected patients to evaluate complex fractures.
MDCT and MRI evaluation of cervical spine trauma
Insights into Imaging, 2013
Purpose Cervical spine injuries following major trauma result in significant associated morbidity and mortality. Devastating neurological injury, including complete and incomplete tetraplegia, are common sequelae of cervical spine trauma and cause profound and life-altering medical, financial, and social consequences. Most cervical spine injuries follow motor vehicle accidents, falls, and violence. The proliferation of multidetector computed tomography allows for fast and accurate screening for potential bony and vascular injuries. Magnetic resonance imaging is useful for evaluation of the supporting ligaments and the spinal cord after the patient has been stabilised. Conclusion Cervical spine injuries are approached with much caution by emergency room clinicians. Thus, it is essential that radiologists be able to differentiate between a stable and unstable injury on MDCT, as this information ultimately helps determine the management of such injuries. Teaching Points: & MDCT and MRI are complementary and both may be needed to define injuries and determine management. & MDCT rapidly evaluates the bones, and MRI is superior for detecting ligament and cord injuries. & Injury to one of the three spinal columns may be stable, and injuries to more than one are unstable. & Instability may cause abnormal interspinous and interpedicular distances, or cervical malalignment. & Fractures of the foramen transversarium are associated with vertebral arterial dissection.