title: Cervical Spinal Cord Injury without Computed Tomography Evidence of Trauma in Adults: Magnetic Resonance Imaging Prognostic Factors.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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 neurologic condition, and MRI results.
  
  
  RESULTS
  There were 48 patients who met the inclusion and exclusion criteria, and 40 who demonstrated improvement in the neurologic examination at follow-up. Disruption of either the anterior longitudinal ligament or ligamentum flavum and larger lesions in the MRI were predictors of lack of neurologic improvement.
  
  
  CONCLUSIONS
  Early MRI has prognostic value in patients suffering SCI without computed tomography evidence of trauma. Lesion length is a powerful predictor of outcome in this subgroup of patients. Soft tissue injury plays a role in the severity of injury and the ability to recover in this subgroups of patients.
authors.affiliation: Department of Clinical Neurological Sciences of University of Western Ontario, London, ON, Canada; Department of Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain. Electronic address: rafa11safin@hotmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Martinez-Perez
authors.affiliation: Department of Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Munarriz
authors.affiliation: Department of Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors.forename: Igor
authors.initials: I
authors.lastname: Paredes
authors.affiliation: Department of Rehabilitation of Hospital Puerta del Mar, Universidad de Cádiz, Cádiz, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Cotrina
authors.affiliation: Department of Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Lagares
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D015897:Comorbidity; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Adults; Cervical trauma; Prognosis; SCIWOCTET; SCIWORA; Spinal cord injury