title: MRI Prognostication Factors in the Setting of Cervical Spinal Cord Injury Secondary to Trauma.
abstract: OBJECTIVE
  Several studies have looked for an association between radiologic findings and neurologic outcome after cervical trauma. In the current literature, there is a paucity of evidence proving the prognostic role of soft tissue damage or bony integrity. Our objective is to determine radiologic findings related to neurologic prognosis in patients after incomplete acute traumatic cervical spinal cord injury, regardless of initial neurologic examination results.
  
  
  METHODS
  We retrospectively reviewed patients with acute traumatic cervical spinal cord injury who had a magnetic resonance imaging (MRI) performed within the first 96 hours. Clinical and epidemiologic data were recorded from the medical records along with several radiologic findings from the initial computed tomographic scan and MRI. Data were analyzed using a non-parametric test. Significant prognostic factors were analyzed through a stepwise multivariable logistic regression, adjusted by neurologic status at baseline. The receiver-operating characteristic curve was used to test the discriminative capacity of the model.
  
  
  RESULTS
  Eighty-six patients (68 males and 18 females) were included for the analysis. Mean age was 49 years. Ligamentum flavum injury, intramedullary edema larger than 36 mm, and facet dislocation were demonstrated to be associated with a lack of neurologic improvement at follow-up. Multivariable analysis showed that edema larger than 36 mm and facet dislocation were strong predictors of clinical outcome, regardless of the initial neurologic examination result.
  
  
  CONCLUSIONS
  Early MRI has an intrinsic prognostic value. Ligamentous injury and larger edema are strong predicting factors of a bad neurologic outcome at long-term follow-up.
authors.affiliation: Department of Clinical Neurological Sciences of University of Western Ontario, London, 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: Martínez-Pérez
authors.affiliation: Department of Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Cepeda
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 Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Alen
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; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Cervical; MRI; Neurologic recovery; Outcome; Prognostic; Spinal cord injury; Spine; Spine trauma