A prospective serial MRI study following acute traumatic cervical spinal cord injury

Rutges, J.P.H.J.; Kwon, Brian K.; Heran, Manraj K. S.; Ailon, Tamir; Street, John; Dvorak, Marcel F.

doi:10.1007/s00586-017-5097-4

Cited by 40 publications

(23 citation statements)

References 23 publications

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“…An inherent limitation of retrospective studies is that researchers are limited to data available for analyses, and for this study, the earliest imaging available averaged 3.7 ± 2.8 weeks. This is a possible confounder, as SCI imaging characteristics are dynamic, especially within the first 3 weeks of injury [26]. Although only one blinded researcher performed the measures in this study (which is a limitation), we are confident in the results as evidenced by reported high levels of inter-rater reliability with the same measures [11].…”

Section: Limitationsmentioning

confidence: 80%

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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Study design Retrospective. Objectives Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting University/hospital. Methods Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577.

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Section: Limitationsmentioning

confidence: 80%

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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“…In severe injuries, the edema and hematoma can appear and increase in the first 48 hours and decrease gradually in the next three weeks, while hematoma indicates that Asia grade in the patient is A, or B, or some patients with C grade [ 23 ]. Grade A and B and neurodegenerative disorders at admission affect the prognosis [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI

Alshorman

Zeng

Wang

et al. 2021

Journal of Healthcare Engineering

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Background. The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation. Purpose. This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma. Method. Between Jan 2017–Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique). Result. The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks. Conclusion. The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (12–48 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.

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“…Further studies with specific subgroups of patients are needed to settle the role of early decompression both for complete and incomplete SCI. [50][51][52] The same group performed a metanalysis using as surgical timing within 24 hours and they failed to demonstrate a better outcome related to time of surgery. However, they only included patients with thoracic and thoracolumbar injury and this represents a bias of this study due to the lower incidence of trauma at this level with respect to cervical SCI and the fact that at lumbar level the injury affects less quality of life for those patients.…”

Section: Emergency Care and Early Managementmentioning

confidence: 99%

Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations

et al. 2020

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A prospective serial MRI study following acute traumatic cervical spinal cord injury

Cited by 40 publications

References 23 publications

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI

Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations

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