Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury

Mabray, Marc C.; Talbott, Jason F.; Whetstone, William D.; Dhall, Sanjay S.; Phillips, David B.; Pan, Jonathan Z.; Manley, Geoffrey T.; Bresnahan, Jacqueline C.; Beattie, Michael S.; Haefeli, Jenny; Ferguson, Adam R.

doi:10.1089/neu.2015.4093

Cited by 41 publications

(27 citation statements)

References 58 publications

(56 reference statements)

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“…In a smaller study by the same authors on thoracolumbar injury, markers of extrinsic cord compression highly correlated with surgical decompression. 51 Together, these studies support the role of T2-weighted MRI and emerging statistical tools to delineate clusters of multidimensional risk factors impacting critical care decisions and outcome following multisystem injury.…”

Section: 49mentioning

confidence: 63%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during immediate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. Venous thromboembolism prophylaxis using low-molecular-weight heparin is recommended by current guidelines for SCI. For these patients, titration of tidal volumes is important to balance the association of earlier weaning off the ventilator, with its risk of atelectasis, against the risk for lung damage from mechanical overinflation that can occur with prolonged ventilation. Careful evaluation of infection risk is a priority following multisystem trauma for patients with relative immunosuppression or compromise. Although patients with polytrauma may experience longer rehabilitation courses, long-term neurological recovery is generally comparable to that in patients with isolated SCI after controlling for demographics. Bowel and bladder disorders are common following SCI, significantly reduce quality of life, and constitute a focus of targeted therapies. Emerging biomarkers including glial fibrillary acidic protein, S100β, and microRNAs for traumatic SCIs are presented. Systematic management approaches to minimize sources of secondary injury are discussed, and areas requiring further research, implementation, and validation are identified.

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Section: 49mentioning

confidence: 63%

Update on critical care for acute spinal cord injury in the setting of polytrauma

Yue

Winkler

Rick

et al. 2017

Neurosurgical Focus

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“…The inter-rater reliability and BASIC axial MRI grading has been previously described as follows. 4, 30 Briefly, Grade 0: no cord signal abnormality; Grade 1: T2 hyperintensity confined to the gray matter; Grade 3: T2 hyperintensity involving gray and some but not all of the white matter; Grade 4: T2 hyperintensity involving the entire axial plane of the spinal cord; Grade 5: grade 3 injury with the addition of foci of T2 hypointensity consistent with hemorrhage. Sagittal grading was assigned as previously described: Grade 1: no spinal cord signal abnormality; Grade 2: single level T2 hyperintensity; Grade 3: >1 vertebral level T2 signal hyperintensity; Grade 4: T2 signal hyperintensity with areas of hypointensity representing hemorrhage.…”

Section: Methodsmentioning

confidence: 99%

“…This concept has been demonstrated in pre-clinical studies and recently in human studies introducing an axial scoring system known as the Brain and Spinal Injury Center (BASIC) score. 4, 23–30 However, until now it is unclear how the axial grading relates to other imaging biomarkers of the sagittal plane and extrinsic compression measures.…”

Section: Introductionmentioning

confidence: 99%

Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury

Haefeli

Mabray

Whetstone³

et al. 2016

AJNR Am J Neuroradiol

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Background and Purpose To assess the relationship between early MRI biomarkers after acute cervical spinal cord injury (SCI) and to evaluate their predictive validity of neurologic impairment. Materials and Methods We performed a retrospective cohort study of 95 patients with acute SCI and pre-operative MRI within 24 hours of injury. American Spinal Injury Association Impairment Scale (AIS) was used to define neurological impairment as our primary outcome measure. We assessed several MRI features of injury including axial grade (BASIC score), sagittal grade, length of injury, maximum canal compromise (MCC), and maximum spinal cord compression (MSCC). Data-driven non-linear principal component analysis (NL-PCA) was followed by correlation and optimal-scaled multiple variable regression to predict neurologic impairment. Results NL-PCA identified two clusters of MRI variables related to 1) measures of intrinsic cord signal abnormality and 2) measures of extrinsic cord compression. Neurologic impairment was best accounted for by MRI measures of intrinsic cord signal abnormality, with axial grade (BASIC score) representing the most statistically significant and accurate predictor of short-term impairment, even when correcting for surgical decompression and degree of cord compression. Conclusions This study demonstrates the utility of applying NL-PCA for defining the relationship between MRI biomarkers in a complex clinical syndrome of cervical SCI. Of the assessed imaging biomarkers, the intrinsic measures of cord signal abnormality were most predictive of neurologic impairment in acute SCI, highlighting the value of axial T2 MRI.

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“…The Brain and spinal injury center score TO THE EDITOR: I read with great interest the article by Talbott et al 1 (Talbott JF, Whetstone WD, Readdy WJ, et al: The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine 23:495-504, October 2015).…”

Section: Neurosurgical Forummentioning

confidence: 99%

Letter to the Editor: The Brain and Spinal Injury Center score

Bhangoo¹

2016

SPI

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Multidimensional Analysis of Magnetic Resonance Imaging Predicts Early Impairment in Thoracic and Thoracolumbar Spinal Cord Injury

Cited by 41 publications

References 58 publications

Update on critical care for acute spinal cord injury in the setting of polytrauma

Update on critical care for acute spinal cord injury in the setting of polytrauma

Multivariate Analysis of MRI Biomarkers for Predicting Neurologic Impairment in Cervical Spinal Cord Injury

Letter to the Editor: The Brain and Spinal Injury Center score

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