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A prospective study of neurological outcome in relation to findings of imaging modalities in acute spinal cord injury.

Singh R, Kumar RR, Setia N, Magu S - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: Improvement in canal dimensions (P = 0.001), beck index (P = 0.008), spinal cord edema (P = 0.010) and stenosis (P = 0.001) was more significant in patients managed operatively; but it was not associated with improved neurological outcome.Patients presenting with complete SCI improved neurologically to a lesser extent.Quantitative and qualitative parameters measured on MRI have a significant role in predicting initial severity of neurological status and outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.

ABSTRACT

Aim: The aim was to correlate the clinical profile and neurological outcome with findings of imaging modalities in acute spinal cord injury (SCI) patients.

Subjects and methods: Imaging (radiographs, computed tomography [CT], and magnetic resonance imaging [MRI]) features of 25 patients of acute SCI were analyzed prospectively and correlated with clinical and neurology outcome at presentation, 3, 6 and 12 months.

Results: Average initial sagittal index, Gardner's index, and regional kyphosis were 8.12 ± 3.90, 15.68 ± 4.09, 16.44 ± 2.53, respectively; and at 1-year were 4.8 ± 3.03, 12.24 ± 4.36, 12.44 ± 2.26, respectively. At presentation patients with complete SCI had significantly more compression percentage (CP) (P < 0.001), maximum canal compromise (P < 0.001), maximum spinal cord compression (P < 0.001), in comparison to incomplete SCI patients. Qualitative MRI findings; hemorrhage, cord swelling, stenosis showed a predilection toward complete SCI. Improvement in canal dimensions (P = 0.001), beck index (P = 0.008), spinal cord edema (P = 0.010) and stenosis (P = 0.001) was more significant in patients managed operatively; but it was not associated with improved neurological outcome. Cord edema was found more in incomplete SCI patients. Patients presenting with complete SCI improved neurologically to a lesser extent.

Conclusions: The present study concludes that imaging modalities in spinal cord injuries have a major role in diagnosis, directing management and predicting prognosis. Imaging findings of severe kyphotic deformities, higher canal and cord compression, lesion length, hemorrhage, and cord swelling are associated with poor initial neurological status and recovery. Quantitative and qualitative parameters measured on MRI have a significant role in predicting initial severity of neurological status and outcome. Operative intervention helps in improving few of these imaging parameters, but not ultimate neurological outcome. MRI is an excellent modality to evaluate acute SCI, and MR images obtained in the acute period significantly and usefully predict neurological outcome.

No MeSH data available.


Related in: MedlinePlus

A 65-year-old female had a road side accident 28 h prior to investigations. Clinical examination showed initial AIS Grade A. Radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) features at the time of initial presentation. (a and b) Plain radiograph (anteroposterior and lateral views) shows wedge collapse of the D12 vertebra. Radiological measurements showed sagittal index, Gardener's index, and regional kyphosis values of 7°, 14°, and 15° respectively. CT scan measurements showed canal dimensions, compression percentage, and Beck index values of 15.21, 6%, and 0.95, respectively, (c and d) MRI sagittal T1-weighted, (e) sagittal T2-weighted, (f) and axial T2-weighted (g) images show maximum spinal cord compression, maximum canal compromise, and lesion length values of 23%, 43%, and 86.06 mm respectively. Hemorrhage, cord swelling, soft tissue injury, body fracture, altered marrow signal, and posterior ligamentous complex injury are also present
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Figure 3: A 65-year-old female had a road side accident 28 h prior to investigations. Clinical examination showed initial AIS Grade A. Radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) features at the time of initial presentation. (a and b) Plain radiograph (anteroposterior and lateral views) shows wedge collapse of the D12 vertebra. Radiological measurements showed sagittal index, Gardener's index, and regional kyphosis values of 7°, 14°, and 15° respectively. CT scan measurements showed canal dimensions, compression percentage, and Beck index values of 15.21, 6%, and 0.95, respectively, (c and d) MRI sagittal T1-weighted, (e) sagittal T2-weighted, (f) and axial T2-weighted (g) images show maximum spinal cord compression, maximum canal compromise, and lesion length values of 23%, 43%, and 86.06 mm respectively. Hemorrhage, cord swelling, soft tissue injury, body fracture, altered marrow signal, and posterior ligamentous complex injury are also present

Mentions: Table 6 shows MRI parameters from the time of presentation to subsequent follow-ups. Average MSCC was initially 34 ± 0.31 which improved to 19 ± 0.21 (by 44%) in 3 months. It further improved by 12% in next 3 months and improved by 12% in next 6 months (at 1-year) follow-up. Patients with complete injury had more MSCC in comparison to incomplete injury as well as neurologically healthy patients [Table 5]. MSCC >50% was present in 8 (32%) of 25 patients. In patients with MSCC >50% at the time of admission, neurological deficit was present in all patients. Neurological improvement was noted in 7 patients (87.5%), and there was no improvement in 1 patient (12.5%). Average MCC was 54% ± 0.3% initially which improved to 30 ± 0.23 (by 44%) in 3 months. It further improved by 11% in next 3 months and by 9% in next 6 months (at 1-year) follow-up. Patients with complete injury had more MCC in comparison to incomplete injury as well as neurologically healthy patients. MCC >50% was present in 12 (48%) of 25 patients. In patients with MCC >50% at the time of admission, neurological deficit was present in 11 patients. Improvement was noted in 9 patients (81.8%), and no improvement was noted in 2 patients (18.2%). Average lesion length in our subjects was 25.25 ± 29.55 mm initially which improved to 18.15 ± 22.75 (by 28%) in 3 months. It further improved by 19% in next 3 months and by 16.4% in next 6 months (at 1-year) follow-up. Decrease in lesion length was particularly significant in patients managed operatively [Table 4]. Lesion length >50 mm was present in 6 (24%) of 25 patients. In patients with lesion length >50 mm at the time of admission, neurological deficit was present in 5 patients. Neurological improvement was noted in 4 patients (80%), and no improvement was noted in 1 patient (20%) with lesion length >50 mm. Spinal cord edema was present in 13 patients initially and in 7 patients at 1-year follow-up. Patients with spinal cord edema showed a predilection toward incomplete SCI at presentation. Patients managed operatively were observed to have significant resolution of edema. In patients with edema at the time of admission, neurological deficit was present in 11 patients. Neurological improvement was noted in 10 patients (90.9%), and there was no improvement in 1 patient (9.1%). Patients with hemorrhage initially had a severe neurological deficit at presentation. In patients with hemorrhage at the time of admission, improvement was noted in 3 patients (75%), and no improvement was noted in 1 patient (25%). Patients with Cord swelling showed a trend toward complete injury at presentation. Patients managed operatively were observed to have significant improvement in stenosis. In patients with stenosis at the time of admission, neurological deficit was present in 14 patients. Neurological improvement was noted in 12 patients (85.7%), and no improvement was noted in 2 patients (14.3%). In patients with altered marrow signal at the time of admission, 20 patients had neurological deficit. Neurological improvement was noted in 17 patients (85%), and no improvement was noted in 3 patients (15%) Radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) features at the time of initial presentation [Figure 3a] and at one year follow up [Figure 3b] in a 65-year-old female.


A prospective study of neurological outcome in relation to findings of imaging modalities in acute spinal cord injury.

Singh R, Kumar RR, Setia N, Magu S - Asian J Neurosurg (2015 Jul-Sep)

A 65-year-old female had a road side accident 28 h prior to investigations. Clinical examination showed initial AIS Grade A. Radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) features at the time of initial presentation. (a and b) Plain radiograph (anteroposterior and lateral views) shows wedge collapse of the D12 vertebra. Radiological measurements showed sagittal index, Gardener's index, and regional kyphosis values of 7°, 14°, and 15° respectively. CT scan measurements showed canal dimensions, compression percentage, and Beck index values of 15.21, 6%, and 0.95, respectively, (c and d) MRI sagittal T1-weighted, (e) sagittal T2-weighted, (f) and axial T2-weighted (g) images show maximum spinal cord compression, maximum canal compromise, and lesion length values of 23%, 43%, and 86.06 mm respectively. Hemorrhage, cord swelling, soft tissue injury, body fracture, altered marrow signal, and posterior ligamentous complex injury are also present
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553729&req=5

Figure 3: A 65-year-old female had a road side accident 28 h prior to investigations. Clinical examination showed initial AIS Grade A. Radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) features at the time of initial presentation. (a and b) Plain radiograph (anteroposterior and lateral views) shows wedge collapse of the D12 vertebra. Radiological measurements showed sagittal index, Gardener's index, and regional kyphosis values of 7°, 14°, and 15° respectively. CT scan measurements showed canal dimensions, compression percentage, and Beck index values of 15.21, 6%, and 0.95, respectively, (c and d) MRI sagittal T1-weighted, (e) sagittal T2-weighted, (f) and axial T2-weighted (g) images show maximum spinal cord compression, maximum canal compromise, and lesion length values of 23%, 43%, and 86.06 mm respectively. Hemorrhage, cord swelling, soft tissue injury, body fracture, altered marrow signal, and posterior ligamentous complex injury are also present
Mentions: Table 6 shows MRI parameters from the time of presentation to subsequent follow-ups. Average MSCC was initially 34 ± 0.31 which improved to 19 ± 0.21 (by 44%) in 3 months. It further improved by 12% in next 3 months and improved by 12% in next 6 months (at 1-year) follow-up. Patients with complete injury had more MSCC in comparison to incomplete injury as well as neurologically healthy patients [Table 5]. MSCC >50% was present in 8 (32%) of 25 patients. In patients with MSCC >50% at the time of admission, neurological deficit was present in all patients. Neurological improvement was noted in 7 patients (87.5%), and there was no improvement in 1 patient (12.5%). Average MCC was 54% ± 0.3% initially which improved to 30 ± 0.23 (by 44%) in 3 months. It further improved by 11% in next 3 months and by 9% in next 6 months (at 1-year) follow-up. Patients with complete injury had more MCC in comparison to incomplete injury as well as neurologically healthy patients. MCC >50% was present in 12 (48%) of 25 patients. In patients with MCC >50% at the time of admission, neurological deficit was present in 11 patients. Improvement was noted in 9 patients (81.8%), and no improvement was noted in 2 patients (18.2%). Average lesion length in our subjects was 25.25 ± 29.55 mm initially which improved to 18.15 ± 22.75 (by 28%) in 3 months. It further improved by 19% in next 3 months and by 16.4% in next 6 months (at 1-year) follow-up. Decrease in lesion length was particularly significant in patients managed operatively [Table 4]. Lesion length >50 mm was present in 6 (24%) of 25 patients. In patients with lesion length >50 mm at the time of admission, neurological deficit was present in 5 patients. Neurological improvement was noted in 4 patients (80%), and no improvement was noted in 1 patient (20%) with lesion length >50 mm. Spinal cord edema was present in 13 patients initially and in 7 patients at 1-year follow-up. Patients with spinal cord edema showed a predilection toward incomplete SCI at presentation. Patients managed operatively were observed to have significant resolution of edema. In patients with edema at the time of admission, neurological deficit was present in 11 patients. Neurological improvement was noted in 10 patients (90.9%), and there was no improvement in 1 patient (9.1%). Patients with hemorrhage initially had a severe neurological deficit at presentation. In patients with hemorrhage at the time of admission, improvement was noted in 3 patients (75%), and no improvement was noted in 1 patient (25%). Patients with Cord swelling showed a trend toward complete injury at presentation. Patients managed operatively were observed to have significant improvement in stenosis. In patients with stenosis at the time of admission, neurological deficit was present in 14 patients. Neurological improvement was noted in 12 patients (85.7%), and no improvement was noted in 2 patients (14.3%). In patients with altered marrow signal at the time of admission, 20 patients had neurological deficit. Neurological improvement was noted in 17 patients (85%), and no improvement was noted in 3 patients (15%) Radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) features at the time of initial presentation [Figure 3a] and at one year follow up [Figure 3b] in a 65-year-old female.

Bottom Line: Improvement in canal dimensions (P = 0.001), beck index (P = 0.008), spinal cord edema (P = 0.010) and stenosis (P = 0.001) was more significant in patients managed operatively; but it was not associated with improved neurological outcome.Patients presenting with complete SCI improved neurologically to a lesser extent.Quantitative and qualitative parameters measured on MRI have a significant role in predicting initial severity of neurological status and outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.

ABSTRACT

Aim: The aim was to correlate the clinical profile and neurological outcome with findings of imaging modalities in acute spinal cord injury (SCI) patients.

Subjects and methods: Imaging (radiographs, computed tomography [CT], and magnetic resonance imaging [MRI]) features of 25 patients of acute SCI were analyzed prospectively and correlated with clinical and neurology outcome at presentation, 3, 6 and 12 months.

Results: Average initial sagittal index, Gardner's index, and regional kyphosis were 8.12 ± 3.90, 15.68 ± 4.09, 16.44 ± 2.53, respectively; and at 1-year were 4.8 ± 3.03, 12.24 ± 4.36, 12.44 ± 2.26, respectively. At presentation patients with complete SCI had significantly more compression percentage (CP) (P < 0.001), maximum canal compromise (P < 0.001), maximum spinal cord compression (P < 0.001), in comparison to incomplete SCI patients. Qualitative MRI findings; hemorrhage, cord swelling, stenosis showed a predilection toward complete SCI. Improvement in canal dimensions (P = 0.001), beck index (P = 0.008), spinal cord edema (P = 0.010) and stenosis (P = 0.001) was more significant in patients managed operatively; but it was not associated with improved neurological outcome. Cord edema was found more in incomplete SCI patients. Patients presenting with complete SCI improved neurologically to a lesser extent.

Conclusions: The present study concludes that imaging modalities in spinal cord injuries have a major role in diagnosis, directing management and predicting prognosis. Imaging findings of severe kyphotic deformities, higher canal and cord compression, lesion length, hemorrhage, and cord swelling are associated with poor initial neurological status and recovery. Quantitative and qualitative parameters measured on MRI have a significant role in predicting initial severity of neurological status and outcome. Operative intervention helps in improving few of these imaging parameters, but not ultimate neurological outcome. MRI is an excellent modality to evaluate acute SCI, and MR images obtained in the acute period significantly and usefully predict neurological outcome.

No MeSH data available.


Related in: MedlinePlus