The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine

Aebli, Nikolaus; Wicki, Anina G.; Rüegg, Tabea B.; Petrou, Nassos; Eisenlohr, Heidrun; Krebs, Jörg

doi:10.1016/j.spinee.2012.10.039

Cited by 71 publications

(39 citation statements)

References 22 publications

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“…This is not a surprising finding, because a male predominance as high as 72% to 96% was also reported in other series (1,7,10,11,14). This is probably due to male dominance in both spinal cord injury and cervical canal stenosis, especially in OPLL.…”

Section: Discussionsupporting

confidence: 78%

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Cervical spinal cord injury in patients with cervical canal stenosis without radiologic evidence of trauma: evaluation of 15 consecutive cases

Eren¹,

Tufan²,

Çetin³

et al. 2017

Bagcilar Medical Bulletin

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Objective: Cervical spinal canal stenosis is a well-known risk factor for spinal cord injury. In some patients, spinal cord injury is the first symptom of spinal stenosis. Therefore, some authors recommend preventive decompression of the spinal canal in asymptomatic patients with spinal stenosis. In this study, we aimed to determine the outcome of patients with spinal cord injury associated with cervical spinal canal stenosis and the rate of previously asymptomatic patients. Material and Methods: Data of 15 consecutive patients were evaluated. Improvement of neurological deficits during followup was accepted as good outcome and mortality and unchanging neurological deficits were accepted as worse outcome. Results: All patients were male, aged between 44 and 85 years. High-energy traumas caused injury in 7 of the cases and low-energy traumas in the others. Nine cases had central cord injury and 6 had other types of traumas. Only 2 patients had been diagnosed with minor symptoms associated with cervical canal stenosis before trauma, while the other patients had been asymptomatic. One patient did not consent to undergo an operation and two others could not be operated because of their general status; the latter 2 patients died. The other 12 patients were decompressed 0 to 40 days after trauma. Two other patients with severe transverse-type cord injury also died postoperatively. The other patients were followed for 1 to 48 months (22.7±17.7 months). In 2 patients, neurological deficits had not improved on last follow-up. Deficits had completely or partly improved in the other patients, including the one who had not accepted the operation. Central cord injury had a significantly better prognosis than other types (p=0.0019). Age, cervical canal diameter, and motor and sensory scores of the American Spinal Injury Association scale, type of trauma, and level of spinal cord injury were not significantly different in the patients with good and worse prognosis. Conclusion:The rate of asymptomatic patients before trauma was very high in patients with spinal cord injury associated with cervical spinal canal stenosis. Therefore, the treatment decision must be carefully assessed in asymptomatic cervical spinal stenosis patients. Catastrophic consequences of spinal trauma may be seen in patients with cervical spinal canal stenosis even in asymptomatic patients. Central cord syndrome had a good prognosis in these patients. Other types of injuries such as transverse and motor types had a worse outcome. Keywords: cervical spinal canal stenosis, spinal cord injuries, spinal cord trauma ÖZET Servikal dar kanal hastalarında radyolojik travma bulgusu olmaksızın servikal omurilik yaralanması: Ardışık 15 olgunun değerlendirilmesi Amaç: Servikal spinal dar kanal omurilik yaralanması için iyi bilinen bir risk faktörüdür. Bazı olgularda kanal darlığının ilk belirtisi omurilik yaralanması olabilir. Bu nedenle bazı yazarlar kanal darlığı olan belirtisiz olgularda önleyici amaçla dekompresyon önermektedir. Bu çalışmada servikal dar ka...

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Section: Discussionsupporting

confidence: 78%

“…In addition, the rate of improvement of neurological deficits after decompression is lower in patients with a more stenotic spinal canal. In 2 studies, Aebli et al identified a Torg-Pavlov ratio of less than 0.7 and a spinal canal diameter of less than 8 mm as risk factors for the development of SCI after trauma (10,11).…”

Section: Discussionmentioning

confidence: 99%

Cervical spinal cord injury in patients with cervical canal stenosis without radiologic evidence of trauma: evaluation of 15 consecutive cases

Eren¹,

Tufan²,

Çetin³

et al. 2017

Bagcilar Medical Bulletin

View full text Add to dashboard Cite

show abstract

“…Recent imaging studies of trauma patients have shown that a cutoff Torg-Pavlov ratio of 0.7 is a possible predictor of symptomatic acute SCI from minor trauma [1]. Still, there is insufficient evidence in the literature to justify preemptive decompression for risk reduction from spinal cord injury, whether it be for lowering the risk from future trauma, or for preventing the development of myelopathy.…”

Section: Significance Of T2-weighted Signal Hyperintensity In Asymptomentioning

confidence: 99%

Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: A review

Ghobrial

Oppenlander

Maulucci

et al. 2014

Clinical Neurology and Neurosurgery

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“…2,14,16 Presently, the Torg-Pavlov ratio (TPR) 19 (ratio of the spinal canal to the vertebral body) is commonly used to assess (congenital) cervical spinal canal stenosis on conventional radiographs. However, the low positive predictive value of the TPR represents a major disadvantage.…”

mentioning

confidence: 99%

“…However, the low positive predictive value of the TPR represents a major disadvantage. 2,7,13,18 Spondylotic changes, which most commonly occur in the vicinity of the intervertebral disc, and canal narrowing caused by soft tissue cannot be assessed with the TPR. 6,20 There is evidence that MRI parameters are more suitable for the evaluation of cervical spinal canal stenosis.…”

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confidence: 99%

The diagnostic value of magnetic resonance imaging measurements for assessing cervical spinal canal stenosis

Rüegg

Wicki

Aebli

et al. 2015

SPI

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OBJECT The authors investigated the relevance of 2D MRI measurements for the diagnosis of critical cervical spinal canal stenosis. Among patients who had sustained a minor cervical spine trauma, they compared MRI measurements of the cervical spine between those with acute cervical spinal cord injury (CSCI) and those without. They also investigated the correlation between the MRI measurements and the severity of CSCI as well as classification accuracy concerning the diagnosis of critical spinal canal stenosis for acute CSCI after a minor trauma. METHODS The authors conducted a single-center retrospective radiological case-control study of patients who had sustained CSCI after a minor trauma to the cervical spine from January 2000 to August 2010. The controls were patients who had sustained a cervical trauma without clinical or radiological signs of cervical spinal cord pathology. On axial T2-weighted MR images, the following were measured: the transverse spinal canal and cord area, the transverse and sagittal cord diameter, and the sagittal canal diameter of the cervical spine (C3–7). Using these measurements, the authors calculated the cord-canal-area ratio by dividing the transverse cord area by the transverse canal area, the space available for the cord by subtracting the sagittal canal diameter from the sagittal cord diameter, and the compression ratio by dividing the transverse cord diameter by its sagittal diameter. The severity of CSCI was assessed by using the motor index scores of 10 key muscles at different time points (initially, 1, 3, and 12 months after injury) obtained from the clinical records. The intra- and interobserver reliability of the MRI measurements, intra- and intergroup differences, and correlations between variables were also investigated. Receiver operating characteristic curves were calculated for evaluating the classification accuracy of the imaging variables for CSCI. RESULTS Data for 52 CSCI patients and 77 control patients were analyzed. The intra- and interobserver reliability regarding the MRI measurements ranged from good (0.72) to perfect (0.99). Differences between the CSCI group and the control group were significant (p < 0.001) for all parameters, except for the cord area. The most prominent differences between the groups existed for the spinal canal area, cord-canal-area ratio, and space available for the cord. The classification accuracy was best for the cord-canal-area ratio and the space available for the cord; areas under the curve were 0.99 (95% CI 0.97–1.0) and 0.98 (95% CI 0.95–0.99), respectively. There was no significant (p > 0.05) correlation between any of the imaging parameters and the motor index score at any time point. CONCLUSIONS The cord-canal-area ratio (> 0.8) or the space available for the cord (< 1.2 mm) measured on MR images can be used to reliably identify patients at risk for acute CSCI after a minor trauma to the cervical spine. However, there does not seem to be any association between spinal canal imaging characteristics and the severity of or recovery from CSCI after a minor trauma.

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The Torg-Pavlov ratio for the prediction of acute spinal cord injury after a minor trauma to the cervical spine

Cited by 71 publications

References 22 publications

Cervical spinal cord injury in patients with cervical canal stenosis without radiologic evidence of trauma: evaluation of 15 consecutive cases

Cervical spinal cord injury in patients with cervical canal stenosis without radiologic evidence of trauma: evaluation of 15 consecutive cases

Management of asymptomatic cervical spinal stenosis in the setting of symptomatic tandem lumbar stenosis: A review

The diagnostic value of magnetic resonance imaging measurements for assessing cervical spinal canal stenosis

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