Feasibility and Safety of Cervical Kinematic Magnetic Resonance Imaging in Patients with Cervical Spinal Cord Injury without Fracture and Dislocation

Abstract

Objective: To evaluate the feasibility and safety of cervical kinematic MRI (KMRI) in patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD).Methods: This was a single-institution case-only study. Patients with CSCIWFD were enrolled in our institution from February 2015 to July 2019. Cervical radiography and CT were performed first to exclude cervical tumors, and major fracture or dislocation. Then neutral static and kinematic (flexion and extension) MRI was performed for patients who met the inclusion criteria under the supervision of a spinal surgeon. Any adverse events during the KMRI examination were recorded. Patients received surgical or conservative treatment based on the imaging results and patients' own wishes. The American Spinal Injury Association impairment scale (AIS) grade and the Japanese Orthopedic Association (JOA) score were evaluated on admission, before KMRI examination, and after KMRI examination. For the surgical patients, AIS grade and JOA score were evaluated again 1 week after the operation. The JOA scores were compared among different time points using the paired t-test.Results: A total of 16 patients (12 men and 4 women, mean age: 51.1 [30-73] years) with CSCIWFD were included in the present study. Clinical symptoms included facial trauma, neck pain, paraplegia, paresthesia, hyperalgesia, sensory loss or weakness below the injury level, and dyskinesia. On admission, AIS grades were B for 2 cases, C for 5, and D for 9. A total of 14 patients underwent neutral, flexion, and extension cervical MRI examination; 2 patients underwent neutral and flexion examination because they could not maintain the position for a prolonged duration. No patient experienced deterioration of neurological function after the examinations. The AIS grades and JOA scores evaluated post-examination were similar to those evaluated pre-examination (P > 0.05) and significantly higher than those on admission (P < 0.05). A total of 12 patients received surgical treatment, 11 of whom underwent anterior cervical discectomy and interbody fusion and 1 underwent posterior C3/4 fusion with lateral mass screws. The remaining 4 patients were offered conservative therapy. None of the patients experienced any complications during the perioperative period. The AIS grade did not change in most surgical patients, except that 1 patient changed from grade C to D 1 week after the operation. The JOA score 1 week after surgery was significantly higher than those on admission and around examination for the surgical patients (P < 0.05).Conclusion: Cervical KMRI is a safe and useful technique for diagnosis of CSCIWFD, which is superior to static cervical MRI for therapeutic decision-making in patients with CSCIWFD.

The Role of Magnetic Resonance Imaging to Inform Clinical Decision-Making in Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

“…In addition, one study also reported improved sensitivity of STIR over T2w images (82% vs. 61%) to identify intervertebral disc injury/herniation [ 18 ]. Two studies found 2 and 5 cases, respectively, of acute disc herniation on MRI that were verified by intraoperative findings [ 22 , 23 ]. Another study investigated the diagnostic accuracy of T2w images to detect intramedullary hemorrhage/contusion/edema in patients with SCIWORA compared with direct visualization of the spinal cord, reporting a sensitivity of 100% [ 19 ].…”

“…Seven studies involving SCI were identified that addressed KQ1 ( Table 3 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Five studies calculated the diagnostic accuracy of MRI in relation to intraoperative findings [ 17 , 18 , 19 , 22 , 23 ], one compared against flexion/extension radiographs [ 20 ], and one against CT myelography [ 21 ].…”

“…Seven studies involving SCI were identified that addressed KQ1 ( Table 3 ) [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Five studies calculated the diagnostic accuracy of MRI in relation to intraoperative findings [ 17 , 18 , 19 , 22 , 23 ], one compared against flexion/extension radiographs [ 20 ], and one against CT myelography [ 21 ]. Two studies with overlapping cohorts focused on hyperextension injuries and central cord syndrome [ 17 , 18 ]; both studies investigated detection of ALL injury, demonstrating superior sensitivity of STIR over T2-weighted (T2w) images (88% vs. 61%) [ 18 ] and a specialized MRI radiologist over a general radiologist (86% vs. 68%) [ 17 ].…”

“…Twenty studies provided data relevant to KQ3, regarding if surgery is required, surgical approach, when to operate, determining the need for instrumentation, which levels to decompress, and the need for reoperation after surgery, based upon MRI findings in acute SCI ( Table 5 ) [ 10 , 17 , 21 , 22 , 23 , 24 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 40 , 42 , 44 , 45 , 46 , 47 ].…”

The Assessment of Dynamic Spinal Cord Impingement by Kinematic Magnetic Resonance Imaging in Patients with Traumatic Central Cord Syndrome

“…For example, Bao et al analyzed the safety of kMRI in 16 patients with spinal cord injury and found that it had greater advantages than the neutral position MRI. 11 Nevertheless, as far as we know, no study has evaluated the characteristics of TCCS using kMRI and whether it can be used to identify prognostic factors of TCCS. The current study therefore aimed to assess the characteristics of DSCI by kMRI and to evaluate the risk factors for poor outcomes in patients with TCCS after surgery.…”