title: Magnetic resonance imaging predictors for respiratory failure after cervical spinal cord injury.
abstract: BACKGROUND
  Patients after cervical spinal cord injury (CSCI) may experience ventilator-dependent respiratory failure during the acute hospitalization period. The aim of the study is to identify imaging factors that predict respiratory failure after acute CSCI.
  
  
  METHODS
  We enrolled 108 patients diagnosed with CSCI in 4 years. The definition of respiratory failure consisted of the requirement of a definitive airway and the assistance of mechanical ventilation. Objective neurological function was determined using the classification of the American Spinal Injury Association (ASIA). We evaluated the characteristics of magnetic resonance imaging (MRI) of the cervical spine.
  
  
  RESULTS
  Respiratory failure occurred in 8 (7.40%) of 108 CSCI patients. The ASIA classification of the 108 patients were A (6), B (3), C (60), D (27), and E (12), and the 8 respiratory failure patients were A (3), B (1), and C (4). Seven of 8 patients with respiratory failure and 78 of 100 patients without respiratory failure had a neurological level of C5 or above by the ASIA standards (p=1.000). The imaging level of injury at C3 by MRI was identified in 5 of 8 patients that developed respiratory failure and more frequent than injury at the lower cervical levels (p<0.001). The presence of spinal cord edema was another predictor of respiratory failure (p=0.009).
  
  
  CONCLUSIONS
  MRI can accurately localize CSCI and identify those patients at risk of respiratory failure. Imaging level of injury at C3 and presence of spinal cord edema are both predictors. To prevent secondary cord injury from prolonged hypoxia and facilitate pulmonary care, definitive airways should be established early in high risk patients.
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan. Electronic address: oucu2003@yahoo.com.tw.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Ou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D066193:Cervical Cord / Q000293:injuries*; D004487:Edema / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
keywords: ASIA classification; MRI; Respiratory failure; Spinal cord injury