Predicting neurologic recovery in cervical spinal cord injury with postoperative MR imaging.
METHODS
Prospective, nonrandomized, observational cohort study.


OBJECTIVE
To determine whether the presence of spinal cord hemorrhage and length of hematoma on magnetic resonance imaging (MRI) is predictive of recovery in cervical spinal cord injury (SCI).


BACKGROUND
A clear picture of the location, extent, and severity of traumatic cervical cord injury can be obtained with MRI. Several prognostic studies looked for an association between the degree of SCI, as depicted by MRI, and neurologic outcome. Up to now, an association between the length of hemorrhage and the extent of SCI and motor recovery could not be demonstrated.


METHODS
Twenty-nine patients with acute traumatic cervical spinal cord injury underwent surgery within 2 to 9 hours. MRI was performed within 2 weeks of injury. Neurologic impairment was classified using the ASIA classification. The effects of hemorrhage and length of hematoma on changes in the neurologic impairment were assessed at time of MRI and at median follow-up in 35 months (range, 24-65 months).


RESULTS
Patients with hemorrhage were much more likely to have a complete injury at time of follow-up (odds ratio = 2.33, 95% confidence interval, 1.42-3.82). Patients admitted with complete SCI, ASIA A, showed a median length of hematoma of 10.5 mm and a median length of edema of 66.5 mm and no change at follow-up. Patients with incomplete SCI showed a median length of hematoma of 4 mm and small edema. Presence of hemorrhage less than 4 mm was associated with good prognosis.


CONCLUSIONS
This study indicates that presence of hemorrhage of less than 4 mm was not associated with complete SCI and showed good prognosis.
Boldin
Christian
C
Department of Traumatology, Medical University Graz, Graz, Austria. christian.boldin@meduni-graz.at
Raith
Johann
J
Fankhauser
Florian
F
Haunschmid
Christian
C
Schwantzer
Gerold
G
Schweighofer
Franz
F
D002574:Cervical Vertebrae; D015331:Cohort Studies; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D009420:Nervous System / Q000503:physiopathology; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013116:Spinal Cord / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome