J Korean Soc Spine Surg.  2009 Dec;16(4):235-242. 10.4184/jkss.2009.16.4.235.

Diagnosis and Prognosis of Adult Post-traumatic Cervical Cord Injury Without Radiographic Evidence of Trauma Using Magnetic Resonance Imaging

• Park HJ
• Lee PE
• Kim WK
• Shim YJ

• KMID: 1819804
• DOI: http://doi.org/10.4184/jkss.2009.16.4.235

Abstract

STUDY DESIGN: This is a retrospective review of 10 consecutive patients with spinal cord injury without radiographic evidence of abnormalities (SCIWORA) and 17 spinal cord injury patients without radiographic evidence of trauma (SCIWORET).
OBJECTIVES
We wanted to assess the MRI and clinical findings, the prognosis and effect of anterior decompression of the spinal cord in SCIWORET patients. SUMMARY OF THE LITERATURE REVIEW: SCIWORET is not uncommon among middle-age and elderly people. It is less reported in adults as compared with children. There are no studies on the method for the treatment or the effectiveness of anterior decompression of the spinal cord.
MATERIALS AND METHODS
From February 1994 to December 2005, this study included 27 patients who had cervical spinal cord injury without radiographic evidence of trauma on the plain roentgenography and MRI. Ten patients had no spinal cord compression (SCIWORA patients, group 1) and 17 had their spinal cord compressed from the anterior (SCIWORET patients, group 2), We conservatively treated the group 1 patients and 10 of the group 2 patients, and anterior decompression and fusion were done for 7 of the group 2 patients. Neurological evaluation was performed initial and at last follow up using an ASIA motor score and the Frankel grade.
RESULTS
The patients who had spinal cord edema on MRI had a better prognosis than those who had contusion (p=0.06). There is no statistical difference between the two groups for the neurologic changes at the initial period and the last follow up period (p=0.06, 0.61). Decompression of the spinal cord anteriorly was not effective for the neurologic recovery (p=0.25) and the involved segments were not related to the neurologic changes (p=0.34, 0.25).
CONCLUSIONS
It was presumed that patients with edema of the spinal cord had a better prognosis than those with contusion of the spinal cord. There was no difference between the SCIWORA and SCIWORET groups for the neurologic changes and anterior decompression was not effective for the recovery of neurologic symptoms. This study was limited by its retrospective nature and the small number of patients, so a multi-center study is needed.

Keyword

Cervical cord injury; MRI; Prognosis

MeSH Terms

Adult
Aged
Asia
Child
Contusions
Decompression
Edema
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Neurologic Manifestations
Prognosis
Retrospective Studies
Spinal Cord
Spinal Cord Compression
Spinal Cord Injuries

Figure

• 

  Fig. 1. 58-year old man with acute spinal cord injury. MRI of the cervical spine was obtained trauma day(A, B) and 12 months (C, D) after injury. (A) Sagittal midline T1-weighetd image shows isointensity cord lesion at C3-4. (B) T2-weighted image shows diffuse hyperintensity cord lesion at C3-4, indicating the existence of edema. (C) Sagittal midline T1-weighted image shows isointensity lesion at C3-4 level. (D) T2-weighted image shows ill defined diffuse hyperintensity lesion at C3-4 level, indicating gliosis.

• 

  Fig. 2. A 48-year old woman presenting Frankel C. MRI of the cervical spine was obtained 2 days (A, B) after injury and 1 year (C, D, E) after anterior decompression and fusion. (A) Sagittal T1-weighted image shows slightly hypointensity cord lesion at C4-5. (B) T2-weighted image shows relatively well defined hyperintensity cord lesion at C4-5, indicating existence of cord contusion, and slightly protruded disc. (C) Sagittal midline T1-weighted image shows isointensity lesion at C4-5 level. (D) T2-weighted image shows ill defined diffuse hyperintensity lesion at C4-5 level. (E) T1-weighted Gadullium enhanced image shows hypointensity(not enhanced) lesion at C4-5 level, indicating gliosis.

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