Spinal Cord Injury after Blunt Cervical Spine Trauma: Correlation of Soft-Tissue Damage and Extension of Lesion

Martínez-Pérez, Rafael; Paredes, Igor; Cepeda, Santiago; Ramos, Ana; Castaño‐León, Ana M.; García-Fuentes, C.; Lobato, Ramón; Gómez, Pedro A.; Lagares, Alfonso

doi:10.3174/ajnr.a3812

Cited by 30 publications

(13 citation statements)

References 37 publications

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“…Over the last decade, MDCT has been considered the benchmark for clearance of spinal trauma patients as a result of robust data acquisition and provided spatial resolution[44]. Though further MR imaging may not be warranted, the utility of MRI in assessing the severity of soft tissue injuries may affect clinical outcomes and should not be underestimated, especially in spinal cord injury (SCI) patients[45]. Over the years, conventional MR sequences like TSE and STIR depicted the presence and extent of subtle vertebral fractures and spinal cord edema.…”

Section: Spinal Traumamentioning

confidence: 99%

Imaging of the spine: Where do we stand?

Nouh

2019

WJR

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The number of patients presenting with spine-related problems has globally increased, with an enormous growing demand for the use of medical imaging to address this problem. The last three decades witnessed great leaps for diagnostic imaging modalities, including those exploited for imaging the spine. These developments improved our diagnostic capabilities in different spinal pathologies, especially with multi-detector computed tomography and magnetic resonance imaging, via both hardware and software improvisations. Nowadays, imaging may depict subtle spinal instability caused by various osseous and ligamentous failures, and could elucidate dynamic instabilities. Consequently, recent diagnostic modalities can discern clinically relevant spinal canal stenosis. Likewise, improvement in diagnostic imaging capabilities revolutionized our understanding of spinal degenerative diseases via quantitative biomarkers rather than mere subjective perspectives. Furthermore, prognostication of spinal cord injury has become feasible, and this is expected to be translated into better effective patient tailoring to management plans with better clinical outcomes. Meanwhile, our confidence in diagnosing spinal infections and assessing the different spinal instrumentation has greatly improved over the past few last decades. Overall, revolutions in diagnostic imaging over the past few decades have upgraded spinal imaging from simple subjective and qualitative indices into a more sophisticated yet precise era of objective metrics via deploying quantitative imaging biomarkers.

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Section: Spinal Traumamentioning

confidence: 99%

Imaging of the spine: Where do we stand?

Nouh

2019

WJR

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“…Disruption of the discoligamentous complex is often associated with a concomitant spinal cord lesion. There is a positive correlation between the number of disrupted ligaments, particularly disruption of the ligamentum flavum, and the length of the spinal cord lesion [9]. Our patient with complete laceration of the IS, ligamentum flavum, ALL and a tear in the PLL was expected to have a large spinal cord lesion.…”

Section: Discussionmentioning

confidence: 72%

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

Alexander

Dowlati

McGowan

et al. 2019

Spinal Cord Ser Cases

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Introduction Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions. Case presentation We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries. Discussion Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.

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“…Injury to PLL was seen in 36.7% (21 patients) of patients and out of that 59% had partial tear and the rest had complete tear. In the study (Spinal Cord Injury after Blunt Cervical Spine Trauma: Correlation of Soft-Tissue Damage and Extension of Lesion) by Martinez-Perez et al, 16 52.8% patients had ALL injury and 58.3% patients had PLL injury. Our study showed a reduced frequency of ALL injury and PLL injury.…”

Section: Discussionmentioning

confidence: 94%

Prognostic Value of Magnetic Resonance Imaging Findings in Acute Spinal Trauma

Thomas¹,

Rajan²,

Rajendran³

et al. 2016

jemds

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AIM To assess the prognostic value of MRI findings in acute spinal trauma by assessing the neurological outcome after an interval period (3-4 months) and correlating it with the different MRI patterns of injury. METHODOLOGYSixty patients with acute spinal trauma presenting to Calicut Medical College with neurological deficit for MR imaging were included in the study after applying the inclusion and exclusion criteria. MRI imaging of the spine was done and patients were divided into three groups based on the MR imaging pattern of cord injury (single level oedema, multi-level oedema, and cord haemorrhage). Neurological status of the patients were assessed at the time of presentation and at the followup period. Neurological outcome was categorised into good, fair, and poor based on the change in neurological status over the followup period. RESULTS AND INTERPRETATIONIn the study population, frequency of Spinal Cord Injury (SCI) was more common in males (90%) compared to females (10%). Majority of the patients belonged to the 20-60 years age group with highest incidence in 41-60 year age group and less number of patients at extremes of age. Most common cause was found to be road traffic accident followed by fall, assault, and sports injury. Cervical cord was the most commonly affected in traumatic injuries of the spine. There was statistically significant association between PLL injury and neurologic outcome. Statistically significant association was found between the neurologic outcome and the abnormal MRI signal patterns of cord injury. CONCLUSIONSMRI is useful for not only for initial diagnosis of acute spinal cord injury, but also for its prognostication and predicting neurological recovery. HOW TO CITE THIS ARTICLE: ThomasA, Rajan P, Rajendran VR, et al. Prognostic value of magnetic resonance imaging findings in acute spinal trauma.

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Spinal Cord Injury after Blunt Cervical Spine Trauma: Correlation of Soft-Tissue Damage and Extension of Lesion

Cited by 30 publications

References 37 publications

Imaging of the spine: Where do we stand?

Imaging of the spine: Where do we stand?

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

Prognostic Value of Magnetic Resonance Imaging Findings in Acute Spinal Trauma

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