title: Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.
abstract: OBJECTIVE
  In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length.
  
  
  METHODS
  We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression.
  
  
  RESULTS
  There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion.
  
  
  CONCLUSIONS
  In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies. Ligamentous injury detected by MR imaging is not a dynamic finding; thus it proved to be useful in predicting neurologic outcome in patients for whom the MR imaging examination was delayed.
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.) rafa11safin@hotmail.com.
authors: R
authors: R
authors: Martínez-Pérez
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.).
authors: I
authors: I
authors: Paredes
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.).
authors: S
authors: S
authors: Cepeda
authors: Radiology (A.R.).
authors: A
authors: A
authors: Ramos
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.).
authors: A M
authors: AM
authors: Castaño-León
authors: Intensive Care Unit (C.G.-F.), Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
authors: C
authors: C
authors: García-Fuentes
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.).
authors: R D
authors: RD
authors: Lobato
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.).
authors: P A
authors: PA
authors: Gómez
authors: From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.).
authors: A
authors: A
authors: Lagares
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology*; D016103:Spinal Fractures / Q000150:complications* / Q000175:diagnosis; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult