Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit.

Flanders, Adam E.; Schaefer, Dale; Doan, H T; Mishkin, Mark M.; González, Candela; Northrup, Bruce E.

doi:10.1148/radiology.177.1.2399326

Cited by 314 publications

(133 citation statements)

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“…2 ± 7 Except for the Flanders et al 7 study, prior studies are based on small numbers, 2,3,5 or technical descriptions of MR scanners and their accuracy in depicting cord pathology. 3,4 The early studies 2 ± 4 focused on the correlation of MR imaging results with neurological prognosis, and reported that the presence of hemorrhage, edema, or cord compression on MRI was an indicator of poor neurological recovery.…”

Section: Resultsmentioning

confidence: 99%

Magnetic resonance imaging and neurological recovery in acute spinal cord injury: observations from the National Acute Spinal Cord Injury Study 3

Shepard

Bracken

1999

Spinal Cord

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Study design: Data are from a multicenter, randomized, double blind clinical trial of acute spinal cord injury. Objectives: To evaluate the prognostic value of magnetic resonance imaging (MRI) for randomized patients in the National Acute Spinal Cord Injury Study 3 (NASCIS). Setting: Sixteen spinal cord injury centers throughout the United States and Canada. Methods: Of 499 patients randomized in NASCIS 3 between December 1991 and September 1995, MRI was electively done on 191 patients within 72 h of injury. Indications of hemorrhage, edema, and contusion were recorded by standard protocol. Neurological impairment as determined by motor function, response to pin prick and light touch was assessed at admission to the participating center and 6 weeks after injury. Change in neurological function was obtained by subtracting the score of each neurological parameter at admission from that measured at 6 weeks. Spinal cord surgery performed within the 3 days after injury was noted. Data were analyzed by: chi square, analysis of variance, multiple logistic regression and linear regression models. Results: Patients with hemorrhage were much more likely to have a complete injury (OR=2.88, 95 Cl 1.32, 6.23); however this association was much reduced when the initial neurological examination was taken into account (AOR=1.43, 95% Cl 0.55, 3.73) and was no longer a signi®cant predictor of injury. MRI evidence of cord edema was the strongest predictor of reduced improvement in motor function (73.34 points, P=0.06) and light touch sensation (73.41 points, P=0.05) at 6 weeks. Conclusions: Cord hemorrhage, contusion, and edema on MRI were not associated with diagnosis of a complete cord injury after neurological assessment from the initial clinical examination was taken into account. Prediction of a worse 6 week neurological status was weakly associated with the presence of edema diagnosed by MRI. As MRI technology improves, these diagnostic and predictive capabilities need to be re-assessed.

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Section: Resultsmentioning

confidence: 99%

Magnetic resonance imaging and neurological recovery in acute spinal cord injury: observations from the National Acute Spinal Cord Injury Study 3

Shepard

Bracken

1999

Spinal Cord

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“…Current studies of prognosis should be undertaken to incorporate new factors such as the DPR and the severity of the damage to the spinal cord by MRI studies. 19 These ®ndings could be used 20 to develop formulas that integrate all of the prognostic factors and take into account the new acute interventions such as improved emergency medical technician (EMT) services and neuroprotective agents. 44 ± 46 The DPR has prognostic signi®cance, when it persists for 48 h or longer in regard to the severity of the injury (ASIA grade) and the potential for ambulation at the time of discharge.…”

Section: Discussionmentioning

confidence: 99%

“…In response to this suggestion and reports by ourselves 14 and others 15 of the presence and prognostic signi®cance of a pathological re¯ex known as the delayed plantar response (DPR), which occurs early after spinal cord injury (SCI), it appeared reasonable to examine more thoroughly re¯ex recovery during the immediate period following SCI. In addition, due to the increased emphasis on relating initial neurological ®ndings alone to functional recovery 16 ± 18 or combined with imaging studies 19,20 electrophysiological studies 21,22 and histopathology, 23,24 the following study was undertaken.…”

Section: Introductionmentioning

confidence: 99%

The pattern of reflex recovery during spinal shock

et al. 1999

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Study Design: A prospective descriptive study of the course of recovery of re¯exes following acute spinal cord injury (SCI). Objectives: The purpose of the study was to observe the pattern of re¯ex recovery following acute SCI in order to determine the prognostic signi®cance of re¯exes for ambulation and their relationship to spinal shock. Setting: A regional spinal cord injury center in Philadelphia, Pennsylvania, USA. Methods: Fifty subjects admitted consecutively over a 9 month period and on the day of injury were observed for the following re¯exes; bulbo-cavernosis (BC), delayed plantar response (DPR), cremasteric (CRM), ankle jerk (AJ), knee jerk (KJ), and normal plantar response for 5 ± 7 days a week and 6 ± 8 weeks duration. The 50 subjects were assessed for ambulation of 200 feet at time of discharge. MRI studies were reviewed on 13/28 complete (ASIA A) injuries. Results: Thirty-®ve subjects (28 ASIA A, 4 ASIA B, 3 ASIA C) had a DPR of 2 days or longer duration and these subjects were not ambulatory. The fourteen subjects (12 ASIA D and 2 ASIA C), who were ambulatory, either had no DPR (11/14) or had a DPR of only 1 days duration (3/14). One subject (ASIA B) was not ambulatory and had a DRP of 1 days duration. The DPR was the ®rst re¯ex to recover most often, followed by the BC, CRM in the ®rst few days and later followed by the deep tendon re¯exes (AJ & KJ) by 1 ± 2 weeks respectively. Less than 8% of subjects had no re¯exes on the day of injury and the re¯exes did not follow a caudal-rostral pattern of recovery. Conclusions: Prognosis for ambulation based on re¯exes early after SCI should not be linked to current descriptions of spinal shock. In fact, the view of spinal shock, based on the absence of re¯exes and the recovery of re¯exes in a caudal to rostral sequence, is of limited clinical utility and should be discarded. The evolution of re¯exes over several days following injury may be more relevant to prognosis than the use of the term spinal shock and the presence or absence of re¯exes on the day of injury.

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“…Patients with injuries below the level of the conus medul laris, or with more than one clinical level of impairment, were excluded. The mechan ism of injury was: motor vehicle accident (16), fall (8), diving (3), assault (3) and recreational sport (3). All patients had temporary spinal immobilisation, with 3 undergoing surgical decompression, be tween 6 hours and 12 days from injury.…”

Section: Methodsmentioning

confidence: 99%

Suggested MRI criteria for surgical decompression in acute spinal cord injury. Preliminary observations

Silberstein¹,

Brown

Tress

et al. 1992

Spinal Cord

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The effect of spinal cord compression identified with magnetic resonance imaging (MRI), on neurological prognosis, was retrospectively evaluated in 36 patients with acute spinal cord injury. Of the 21 patients without cord compres sion, 16 had potentially reversible injury (normal spinal cord or cord oedema), all having functional recovery.Of the 15 patients with cord compression, 3 had operative decompression. In the 12 patients who did not undergo surgery, the degree of recovery was directly related to the magnitude of spinal cord compression, only one of the patients with moderate or marked cord compression having useful motor function at follow up. In contrast, the 3 patients with surgical decompression had at least 2 grades of improvement, all having functional recovery. These findings raise the possibility that MRI may be used to identify a patient group who will benefit from surgical decompression. A numerical index is proposed to prospectively identify patients for surgical decompression, and further studies are underway to evaluate this.

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Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit.

Cited by 314 publications

References 0 publications

Magnetic resonance imaging and neurological recovery in acute spinal cord injury: observations from the National Acute Spinal Cord Injury Study 3

Magnetic resonance imaging and neurological recovery in acute spinal cord injury: observations from the National Acute Spinal Cord Injury Study 3

The pattern of reflex recovery during spinal shock

Suggested MRI criteria for surgical decompression in acute spinal cord injury. Preliminary observations

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