Introduction: The role of MRI in evaluating the acutely injured spine is well established and contributes to assessment of ligamentous disruption, associated disc protrusions as well as exact site of maximal canal stenosis and nature of cord injury; and neurological assessment as per ASIA score is an internationally accepted method. It is not well established the MRI at any point of time correlates with ASIA score to prognosticate neurological recovery. Aims: The present study aimed to evaluate relationship between MRI fi ndings and ASIA score to predict neurological defi cit and recovery in acute SCI patients. Methods: Thirty-fi ve patients of acute spinal cord injury with mean age of 31.34 ± 10.63 years (range 16 to 65 years), who have been presented within 48 hours of injury were included in the study. Complete neurological (ASIA grading) and MRI examinations were done at presentation, 3 months, and 6 months to evaluate the SCI. Statistical analysis of MRI (qualitative & quantitative) fi ndings and clinical evaluation was done with ASIA scoring to fi nd an agreement between MRI and neurological outcome. Results: The statistically signifi cant correlation was found to be with Maximum Canal Compromise (MCC) (-0.703) followed by lesion length (-0.678), Maximum Spinal Cord Compression (MSCC) (-0.661), stenosis (-0.577) and disc herniation (-0.420) to prognosticate the neural recovery as determined by ASIA score. The rest of MRI fi ndings didn't have signifi cant correlation with ASIA score at any point of time. However, decrease in edema signifi cantly correlated with ASIA score at 3 and 6 months post injury. Statistically signifi cant kappa agreement between neurological recovery diagnosed by ASIA score and MRI fi ndings was found with MCC (k=0.211) and soft tissue injury (k=0.318). Conclusions: The present study showed that signifi cant correlation exist between MRI fi ndings (MCC, MSCC, stenosis, and disc herniation) and ASIA score at different point of time post SCI. Furthermore, statistically signifi cant kappa agreement between neurological recovery diagnosed by ASIA score and MRI fi ndings (MCC and soft tissue injury) was found. We suggest that serial neurologic examination and neuroimaging complement each other in prognosticating neurological recovery after acute traumatic SCI.
