Can MRI findings predict the outcome of cervical spinal cord Injury? a systematic review

Tarawneh, Ahmad M.; D’Aquino, Daniel; Hilis, Aaron; Eisa, Amr; Quraishi, Nasir A.

doi:10.1007/s00586-020-06511-7

Cited by 23 publications

(17 citation statements)

References 25 publications

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“…Nevertheless, a reliable assessment of spinal cord compression cannot be adequately assessed using CT alone [ 5 ]. With further developments in technology, MRI is becoming the diagnostic gold standard for CSCI [ 5 , 7 , 13 , 14 , 21 ]. MRI most clearly visualizes extrinsic spinal cord compression and status of the cord medulla.…”

Section: Discussionmentioning

confidence: 99%

“…It also serves to provide prognostic value in terms of neurological recovery. General neurological recovery estimated by Frankel grading was significantly associated with maximal spinal cord compression, length of cord edema, and intramedullary hemorrhage in patients with CSCI [ 21 ]. By contrast, this study focused only on recovery of respiratory function.…”

Section: Discussionmentioning

confidence: 99%

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A Prognostic Factor for Prolonged Mechanical Ventilator-Dependent Respiratory Failure after Cervical Spinal Cord Injury : Maximal Canal Compromise on Magnetic Resonance Imaging

Lee

Roh

Jeon

et al. 2021

J Korean Neurosurg Soc

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Objective : The period of mechanical ventilator (MV)-dependent respiratory failure after cervical spinal cord injury (CSCI) varies from patient to patient. This study aimed to identify predictors of MV at hospital discharge (MVDC) due to prolonged respiratory failure among patients with MV after CSCI.Methods : Two hundred forty-three patients with CSCI were admitted to our institution between May 2006 and April 2018. Their medical records and radiographic data were retrospectively reviewed. Level and completeness of injury were defined according to the American Spinal Injury Association (ASIA) standards. Respiratory failure was defined as the requirement for definitive airway and assistance of MV. We also evaluated magnetic resonance imaging characteristics of the cervical spine. These characteristics included : maximum canal compromise (MCC); intramedullary hematoma or cord transection; and integrity of the disco-ligamentous complex for assessment of the Subaxial Cervical Spine Injury Classification (SLIC) scoring. The inclusion criteria were patients with CSCI who underwent decompression surgery within 48 hours after trauma with respiratory failure during hospital stay. Patients with Glasgow coma scale 12 or lower, major fatal trauma of vital organs, or stroke caused by vertebral artery injury were excluded from the study.Results : Out of 243 patients with CSCI, 30 required MV during their hospital stay, and 27 met the inclusion criteria. Among them, 48.1% (13/27) of patients had MVDC with greater than 30 days MV or death caused by aspiration pneumonia. In total, 51.9% (14/27) of patients could be weaned from MV during 30 days or less of hospital stay (MV days : MVDC 38.23±20.79 vs. MV weaning, 13.57±8.40; p<0.001). Vital signs at hospital arrival, smoking, the American Society of Anesthesiologists classification, Associated injury with Injury Severity Score, SLIC score, and length of cord edema did not differ between the MVDC and MV weaning groups. The ASIA impairment scale, level of injury within C3 to C6, and MCC significantly affected MVDC. The MCC significantly correlated with MVDC, and the optimal cutoff value was 51.40%, with 76.9% sensitivity and 78.6% specificity. In multivariate logistic regression analysis, MCC >51.4% was a significant risk factor for MVDC (odds ratio, 7.574; p=0.039).Conclusion : As a method of predicting which patients would be able to undergo weaning from MV early, the MCC is a valid factor. If the MCC exceeds 51.4%, prognosis of respiratory function becomes poor and the probability of MVDC is increased.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Prognostic Factor for Prolonged Mechanical Ventilator-Dependent Respiratory Failure after Cervical Spinal Cord Injury : Maximal Canal Compromise on Magnetic Resonance Imaging

Lee

Roh

Jeon

et al. 2021

J Korean Neurosurg Soc

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“…In SCI, trauma causes primary injury, followed by secondary injury, including bleeding, ischemia, edema, in ammatory cell in ltration, and neuronal and glial cell death [19]. Intramedullary T2 high-intensity lesions in acute and subacute SCI were reported to primarily re ect edema or hemorrhage [20,21]. In a previous study, MR images of acute and subacute SCI showed that T2 high-intensity lesions with unclear boundary spread in the sagittal direction [20].…”

Section: Discussionmentioning

confidence: 99%

Discrimination between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging

Kamei

Nakanishi

Nakamae

et al. 2020

Preprint

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Background: When intramedullary high-intensity lesions are found on cervical T2-weighted magnetic resonance images of patients with whiplash injury, it is often required to identify whether they are due to spinal cord injury (SCI) or cervical compressive myelopathy (CCM). This is important to determine insurance coverage. Thus, this study aimed to develop a method to distinguish between SCI and CCM.Methods: Magnetic resonance images of 20 patients who had cervical SCI were evaluated. These 20 SCI patients were age- and sex-matched to 20 CCM patients. The number of discs adjacent to T2 high-intensity lesions was counted because the T2 high-intensity lesions in SCI were characterized by sagittal dilation. The “snake-eyes appearance” was assessed as a characteristic finding of CCM. T2 values in T2 high-intensity lesions were evaluated quantitatively by its ratio with the T2 values in the normal spinal cord, including signal ratio and contrast ratio.Results: The number of discs adjacent to T2 high-intensity lesions was significantly higher in SCI than in CCM. The snake-eyes appearance was found in 9 of 20 CCM patients, but not in SCI patients. The signal ratio and contrast ratio on axial images were significantly higher in SCI than in CCM. A new diagnostic scale was created based on these results. This diagnostic scale has made it possible to distinguish SCI and CCM with >90% accuracy from all perspectives including sensitivity, specificity, positive predictive value, and negative predictive value.Conclusions: The features of T2 high-intensity lesions can be used to distinguish between SCI and CCM.

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“…In a balloon SCI model in rabbits, intraparenchymal hemorrhage developed within 5 hours and was the primary cause of cord swelling whereas edema became the primary cause of cord swelling at 5-7 days post-injury (59). Intraparenchymal hemorrhages and cord edema are also evident in human SCI and the length of cord edema and the length of intraparenchymal hemorrhage on MRI (27) as well the mean intraspinal pressure (60), monitored in the first week after SCI, correlate with outcome. Extravasation studies in dog models (61) and diffusionweighted human MRI (62) suggest that cord edema after SCI is cytotoxic (cell swelling) and vasogenic (leaky capillaries) with accumulation of excess water intracellularly and interstitially.…”

Section: Causes Of Spinal Cord Swellingmentioning

confidence: 99%

“…Spinal cord swelling is common after SCI with evidence that the amount of swelling, e.g., longitudinal cord signal change on T2 MRI, correlates with outcome (27). In a cohort of 65 SCI patients without bony compression, the extent of cord swelling against the dura increased with increasing severity of SCI and resolved slowly (t 1/2 = 9 days) (28).…”

Section: Evidence That the Dura Plays A Key Role Humansmentioning

confidence: 99%

Acute Traumatic Spinal Cord Injury in Humans, Dogs, and Other Mammals: The Under-appreciated Role of the Dura

Saadoun

Jeffery

2021

Front. Neurol.

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We review human and animal studies to determine whether, after severe spinal cord injury (SCI), the cord swells against the inelastic dura. Evidence from rodent models suggests that the cord swells because of edema and intraparenchymal hemorrhage and because the pia becomes damaged and does not restrict cord expansion. Human cohort studies based on serial MRIs and measurements of elevated intraspinal pressure at the injury site also suggest that the swollen cord is compressed against dura. In dogs, SCI commonly results from intervertebral disc herniation with evidence that durotomy provides additional functional benefit to conventional (extradural) decompressive surgery. Investigations utilizing rodent and pig models of SCI report that the cord swells after injury and that durotomy is beneficial by reducing cord pressure, cord inflammation, and syrinx formation. A human MRI study concluded that, after extensive bony decompression, cord compression against the dura may only occur in a small number of patients. We conclude that the benefit of routinely opening the dura after SCI is only supported by animal and level III human studies. Two randomized, controlled trials, one in humans and one in dogs, are being set up to provide Level I evidence.

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Can MRI findings predict the outcome of cervical spinal cord Injury? a systematic review

Cited by 23 publications

References 25 publications

A Prognostic Factor for Prolonged Mechanical Ventilator-Dependent Respiratory Failure after Cervical Spinal Cord Injury : Maximal Canal Compromise on Magnetic Resonance Imaging

A Prognostic Factor for Prolonged Mechanical Ventilator-Dependent Respiratory Failure after Cervical Spinal Cord Injury : Maximal Canal Compromise on Magnetic Resonance Imaging

Discrimination between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging

Acute Traumatic Spinal Cord Injury in Humans, Dogs, and Other Mammals: The Under-appreciated Role of the Dura

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