Evaluation of patients with cervical spine injury and predicting the risk and severity of acute spinal cord injury after a minor trauma
Keywords:Spinal cord injury, Cervical spine, Trauma, MRI, Spinal canal stenosis
Background: Acute spinal cord injury (SCI) after a minor trauma to the cervical spine has been reported in patients without preceding neurologic symptoms. Spinal canal stenosis may be the reason for the discrepancy between the severity of the injury and that of the trauma. The objective of this study was to investigate MRI parameters of the cervical spine in patients suffering from acute SCI and to investigate the use of these parameters for predicting the risk and severity of acute cervical SCI after a minor trauma to the cervical spine.
Methods: Retrospective radiological study was conducted in Meenakshi Medical College and Research Institute Kanchipuram with fifty patients suffering from acute cervical SCI and 130 patients showing no neurologic deficits after a minor trauma to the cervical spine. The following calculations were performed using measurements from MR images the spinal canal to vertebral body ratio, the space available for the cord, and the canal-to-cord ratio. SPSS version 21 was used for analysis.
Results: All investigated MR image parameters in the SCI group were significantly (p<001) smaller compared with the control group. However, there was no significant difference in any parameter among the different American spinal injury association impairment score groups. A cut-off value of 8.0 mm for the minimal sagittal disc-level canal diameter yielded the largest positive predictive value and likelihood ratio for predicting SCI.
Conclusions: Patients at risk of acute SCI after a minor trauma to the cervical spine can be identified by applying a disc-level canal diameter cut-off value measured on MR images. Supplementary factors to the radiological characteristics of the spinal canal affect the severity of acute SCI after trauma.
Regenbogen VS, Rogers LF, Atlas SW, Kim KS. Cervical spinal cord injuries in patients with cervical spondylosis. AJR Am J Roentgenol. 1986;146:277-84.
Wick M, Muller EJ, Hahn MP, Muhr G. Spinal contusion after trauma to the cervical spine relevance of the sagittal diameter of the spinal canal. Z Orthop Ihre Grenzgeb. 1999;137:340-4.
Song KJ, Choi BW, Kim SJ. The relationship between spinalstenosis and neurological outcome in traumatic cervical spine injury: an analysis using Pavlov’s ratio, spinal cord area, and spinal canal area. Clin Orthop Surg. 2009;1:11-8.
Eismont FJ, Clifford S, Goldberg M, Green B. Cervical sagittal spinal canal size in spine injury. Spine. 1984;9:663-6.
Firooznia H, Ahn JH, Rafii M, Ragnarsson KT. Sudden quadriplegia after a minor trauma. The role of pre-existing spinal stenosis. Surg Neurol. 1985;23:165-8.
Torg JS, Pavlov H, Genuario SE. Neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am. 1986;68:1354-70.
American College of Surgeons Committee on Trauma. Spine and spinal cord trauma. Advanced trauma life support for doctors ATLS student course manual. 8th ed. Chicago, IL: American College of Surgeons; 2008: 157-86.
Daffner RH. Radiologic evaluation of chronic neck pain. Am Fam Physician. 2010;82:959-64.
Yue WM, Tan SB, Tan MH. The Torg-Pavlov ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a non-spondylotic, non-myelopathic population. Spine. 2001;26:1760-4.
Torg JS, Corcoran TA, Thibault LE. Cervical cord neurapraxia: classification, patho mechanics, morbidity, and management guidelines. J Neurosurg. 1997;87:843-50.
Shin JJ, Jin BH, Kim KS. Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy. Acta Neurochir. 2010;152:1687-94.
Presciutti SM, Luca DP, Marchetto P. Mean sub axial space available for the cord index as a novel method of measuring cervical spine geometry to predict the chronic stinger syndrome in American football players. J Neurosurg Spine. 2009;11:264-71.
Zeidman SM, Ducker TB. Evaluation of patients with cervical spine lesions. In: Clark CR, ed. The cervical spine. 3rd ed. Philadelphia, PA: Lippincott-Raven Publishers; 1998: 143-161.
Murone I. The importance of the sagittal diameters of the cervical spinal canal in relation to spondylosis and myelopathy. J Bone Joint Surg Br. 1974;56:30-6.
Yoo DS, Lee SB, Huh PW. Spinal cord injury in cervical spinalstenosis by minor trauma. World Neuro Surg. 2010;73:50-2.
Suk KS, Kim KT, Lee JH. Re-evaluation of the Pavlov ratio in patients with cervical myelopathy. Clin Orthop Surg. 2009;1:6-10.
Fukushima T, Ikata T, Taoka Y, Takata S. Magnetic resonance imaging study on spinal cord plasticity in patients with cervical compression myelopathy. Spine. 1991;16:534-8.